Mixed hepatocellular-cholestatic liver injury after pioglitazone therapy.
BACKGROUND
Pioglitazone is an oral hypoglycemic agent in the thiazolidinedione class. Only one case of hepatotoxicity related to this agent has previously been reported.


OBJECTIVE
To report the clinical course of a patient with hepatitis after therapy with pioglitazone.


METHODS
Case report.


METHODS
A community hospital.


METHODS
A 49-year-old diabetic man taking pioglitazone, 30 mg/d.


METHODS
Discontinuation of pioglitazone therapy.


METHODS
Serum aminotransferase and bilirubin levels, standard blood tests for causes of hepatitis and cirrhosis other than drug toxicity, and liver biopsy.


RESULTS
After 6 months of pioglitazone therapy, significant hepatic dysfunction developed. Blood tests excluded viral, metabolic, and autoimmune disorders. Liver biopsy showed mixed hepatocellular-cholestatic injury compatible with drug toxicity. After treatment with pioglitazone was discontinued, liver enzyme values returned to normal.


CONCLUSIONS
Patients receiving pioglitazone may develop serious liver injury and should be observed for evidence of hepatitis.
May
Louis D
LD
Good Samaritan Hospital, Suffern, NY 10901, USA.
Lefkowitch
Jay H
JH
Kram
Michael T
MT
Rubin
David E
DE
D001663:Bilirubin / Q000097:blood; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000201:enzymology / Q000209:etiology*; D002780:Cholestasis, Intrahepatic / Q000139:chemically induced* / Q000175:diagnosis / Q000201:enzymology; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D008099:Liver / Q000201:enzymology; D008875:Middle Aged; D000077205:Pioglitazone; D013844:Thiazoles / Q000009:adverse effects*; D045162:Thiazolidinediones; D000637:Transaminases / Q000097:blood
D007004:Hypoglycemic Agents; D013844:Thiazoles; D045162:Thiazolidinediones; D000637:Transaminases; D001663:Bilirubin; D000077205:Pioglitazone