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Published on: October 21, 2017
Mixed hepatocellular-cholestatic liver injury after pioglitazone therapy
Louis D May1, Jay H Lefkowitch, Michael T Kram
1Good Samaritan Hospital, Suffern, NY 10901, USA.
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.
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