Due to the patient's clinical and laboratory improvement, the dose of cyclosporine was reduced to 3 mg/kg and that of solumedrol was reduced to 100 mg three times daily. After 10 days, the patient was successfully extubated and discharged with oral treatment. Two weeks later the patient was readmitted due to spiking fever, arthralgias and maculopapular rashes on her palms. A physical examination revealed jaundiced eyes and her laboratory tests showed serious liver dysfunction, with ALT 791 U/l, AST 611 U/l, alkaline phosphatase 404 U/l, GGTP 2105 U/l, LDH 1683 U/l, and total serum bilirubin at 177 micromol/l. An abdominal ultrasonography revealed that the patient had a normal size liver with a 16.5 cm enlarged spleen and normal pancreas and common bile duct. Her kidneys also appeared normal. Repeat blood tests showed leukopenia of 3200, which further declined to 1100, hemoglobin 11 gr%, platelets 217,000, ESR 92, CRP 4 and ferritin 2680 ng/ml. Her lipid profile disclosed hypercholesterolemia of 15.1 mmol/l (normal range 3 to 5 mmol/ l), HDL 1.66 mmol/l (normal value > 0.91 mmol/l), LDL 11.11 mmol/l (normal range 0 to 3.4 mmol/l) and hypertriglyceridemia 5.0 mmol/l (normal range 0 to 2.3 mmol/ l).