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BRIEF COMMUNICATION

Mixed Hepatocellular–Cholestatic Liver Injury after Pioglitazone Therapy

Louis D. May, MD; Jay H. Lefkowitch, MD; Michael T. Kram, MD; and David E. Rubin, MD

19 March 2002 | Volume 136 Issue 6 | Pages 449-452

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.

Design: Case report.

Setting: A community hospital.

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

Intervention: Discontinuation of pioglitazone therapy.

Measurements: 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.

Conclusion: Patients receiving pioglitazone may develop serious liver injury and should be observed for evidence of hepatitis.

Editors' Notes Context Thiazolidinedione agents are useful in the management of type 2 diabetes mellitus. Unfortunately, the first two drugs in this class, troglitazone and rosiglitazone, have been associated with hepatic injury. In 2001, clinicians reported a case of liver injury associated with pioglitazone, the newest thiazolidinedione. Contribution This report describes mixed hepatocellular–cholestatic liver injury in a patient who had been taking pioglitazone for 6 months. Liver enzyme values returned to normal 6 weeks after the patient discontinued pioglitazone therapy. Implications Hepatic injury can occur in association with pioglitazone as well as with the other drugs in this class. The frequency of this complication and its risk factors remain unknown. –The Editors

 

Author and Article Information

From Good Samaritan Hospital, Suffern, and Columbia Presbyterian Medical Center, New York, New York.

Requests for Single Reprints: Louis D. May, MD, Gastrointestinal Associates of Rockland, 500 New Hempstead Road, New City, NY 10956.

Current Author Addresses: Drs. May and Kram: Gastrointestinal Associates of Rockland, 500 New Hempstead Road, New City, NY 10956.

Dr. Lefkowitch: Columbia Presbyterian Medical Center, 630 West 168th Street, New York, NY 10032.

Dr. Rubin: Good Samaritan Hospital, Route 59, Suffern, NY 10901.

Author Contributions: Conception and design: L.D. May, J.H. Lefkowitch, M.T. Kram.

Analysis and interpretation of the data: L.D. May, J.H. Lefkowitch, D.E. Rubin.

Drafting of the article: L.D. May, J.H. Lefkowitch, M.T. Kram.

Critical revision of the article for important intellectual content: L.D. May, J.H. Lefkowitch, D.E. Rubin.

Final approval of the article: L.D. May, J.H. Lefkowitch, M.T. Kram, D.E. Rubin.

Provision of study materials or patients: L.D. May, M.T. Kram, D.E. Rubin.

Administrative, technical, or logistic support: D.E. Rubin.

Collection and assembly of data: L.D. May, D.E. Rubin.

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