tokens: Fulminant hepatic failure in these cases could be characterized by : ( 1 ) rapid decrease in serum alanine transaminase ( ALT ) level after discontinuation of ecarazine , ( 2 ) prolonged jaundice despite discontinuation of ecarazine , ( 3 ) high incidence of anti - nuclear antibody ( ANA ) ( 57 % ) , and ( 4 ) histological findings of extensive hepatocellular necrosis ranging from bridging necrosis to massive necrosis .