Metformin-induced cholestatic hepatitis.
OBJECTIVE
To report a case of metformin-induced cholestatic hepatitis.


METHODS
We present a detailed case report, including laboratory and biopsy findings. In addition, similar cases from the literature are reviewed.


RESULTS
In a 68-year-old man with newly diagnosed diabetes mellitus, metformin therapy was begun. The dosage initially was 500 mg twice daily and later was increased to 850 mg twice a day. Four weeks after met-formin treatment was initiated, jaundice, pruritus, and liver enzyme abnormalities were noted. The patient underwent an extensive work-up, including a hepatitis screen, ultrasonography, magnetic resonance imaging, and endoscopic retrograde cholangiopancreatography, all of which showed normal findings. A liver biopsy revealed severe cholestasis and mild portal inflammation. Treatment with metformin was discontinued, and the liver enzymes normalized except for a persistently increased level of alkaline phosphatase, most likely related to a prolonged cholestatic effect of metformin.


CONCLUSIONS
Although rare, metformin can be responsible for inducing liver damage, and patients and physicians should be aware of this side effect.
Nammour
Fadel E
FE
Department of Medicine, Division of Gastroenterology, Cooper Hospital, University Medical Center, and Robert Wood Johnson Medical School, Camden, New Jersey 08103, USA.
Fayad
Nabil F
NF
Peikin
Steven R
SR
D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D056486:Chemical and Drug Induced Liver Injury / Q000150:complications* / Q000000981:diagnostic imaging; D002758:Cholangiography; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D041781:Jaundice, Obstructive / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology; D008099:Liver / Q000473:pathology; D008111:Liver Function Tests; D008279:Magnetic Resonance Imaging; D008297:Male; D008687:Metformin / Q000009:adverse effects* / Q000627:therapeutic use; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D008687:Metformin