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Pleural Effusion and Anasarca Associated With Pioglitazone.

Ashwin Jagadish¹, Shahnawaz Notta¹, Stephen Bakeler¹

¹James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA.

The Journal of Pharmacy Technology : Jpt : Official Publication of the Association of Pharmacy Technicians

|June 19, 2025

Summary

Pioglitazone, used for type 2 diabetes, may cause fluid buildup, including rare pleural effusions and anasarca. Discontinuation of the drug led to patient recovery.

Keywords:

anasarca pioglitazone pleural effusion thiazolidinedione type II diabetes mellitus

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Area of Science:

Endocrinology
Cardiology
Pulmonology

Background:

Pioglitazone is a thiazolidinedione medication for type 2 diabetes mellitus (T2DM).
Common adverse effects include edema and weight gain; heart failure is a known risk.
Pleural effusions are an uncommon adverse effect associated with pioglitazone.

Observation:

An 81-year-old male with T2DM presented with worsening lower extremity edema and dyspnea.
Symptoms emerged after initiating pioglitazone therapy.
The patient exhibited a large pleural effusion and diffuse anasarca.

Findings:

Discontinuation of pioglitazone resulted in symptom improvement.
The patient underwent successful thoracentesis and diuresis.
The Naranjo scale indicated a probable association between pioglitazone and the patient's condition (score of 7).

Implications:

This case highlights a rare presentation of pleural effusion and anasarca potentially linked to pioglitazone.
Physicians should consider pioglitazone as a potential cause of unexplained fluid accumulation.
Further research is warranted to understand the mechanism and incidence of pioglitazone-induced pleural effusions.