title: Mixed hepatocellular-cholestatic liver injury after pioglitazone therapy.
abstract: 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.
authors.affiliation: Good Samaritan Hospital, Suffern, NY 10901, USA.
authors.forename: Louis D
authors.initials: LD
authors.lastname: May
authors.forename: Jay H
authors.initials: JH
authors.lastname: Lefkowitch
authors.forename: Michael T
authors.initials: MT
authors.lastname: Kram
authors.forename: David E
authors.initials: DE
authors.lastname: Rubin
mesh_terms: 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
chemical_list: D007004:Hypoglycemic Agents; D013844:Thiazoles; D045162:Thiazolidinediones; D000637:Transaminases; D001663:Bilirubin; D000077205:Pioglitazone