I can recall one similar case – patient didn’t respond to steroids or Cellcept. Viral work-up negative. All other hepatotoxic drugs discontinued (statins, acetaminophen, etc). It unfortunately wasn’t a happy ending for this patient – dealing with it went on for a year. We even referred to a hepatologist. However, this is the ONLY case that I can recall. It’s a reminder that these drugs, though seemingly benign, can still be very toxic and detrimental in a few select cases. Sending him for a biopsy was very appropriate – keep us posted on the outcome.