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Troglitazone-induced hepatic failure leading to liver transplantation. A case report
B A Neuschwander-Tetri1, W L Isley, J C Oki
1St. Louis University School of Medicine, Missouri 63110, USA.
Background:
Troglitazone is a new drug for the treatment of type 2 diabetes. Although mild liver injury occurred in 1.9% of participants in controlled trials, the U.S. Food and Drug Administration has received reports of five postmarketing cases of severe liver disease that resulted in death or liver transplantation.
Objective:
To report the clinical and histopathologic characteristics of a patient with troglitazone-associated severe liver injury leading to transplantation.
Design:
Case report.
Setting:
Two university hospitals.
Patient:
A 55-year-old woman taking troglitazone, 400 mg/d, and insulin, 120 U/d.
Intervention:
Discontinuation of troglitazone therapy, pretransplantation liver biopsy, and liver transplantation.
Results:
Early nonspecific symptoms were attributed to other causes and were not evaluated. After the patient had used troglitazone for 3.5 months, massive loss of liver parenchyma and symptoms of liver failure developed, necessitating liver transplantation.
Conclusion:
Troglitazone may cause subfulminant liver failure.
Insights
Troglitazone, a type 2 diabetes drug, can cause severe liver failure. A case report details a patient who required a liver transplant due to troglitazone-induced liver injury.
Area of Science:
- Hepatology
- Pharmacology
- Internal Medicine
Background:
- Troglitazone is a medication used to treat type 2 diabetes.
- While generally associated with mild liver injury in clinical trials, severe cases have been reported post-marketing.
- The U.S. Food and Drug Administration (FDA) received reports of severe liver disease, including fatalities and transplants.
Observation:
- A case report focused on a 55-year-old woman undergoing treatment for type 2 diabetes.
- The patient was administered troglitazone (400 mg/d) and insulin (120 U/d).
- Initial nonspecific symptoms were overlooked, delaying evaluation.
Findings:
- After 3.5 months of troglitazone therapy, the patient developed massive liver parenchyma loss and liver failure symptoms.
- Liver transplantation became necessary due to the severity of the drug-induced liver injury.
- Histopathological examination of the pretransplantation liver biopsy was performed.
Implications:
- Troglitazone is associated with a risk of subfulminant liver failure.
- This case highlights the potential for severe hepatotoxicity from troglitazone, even in patients without pre-existing liver conditions.
- Healthcare providers should be vigilant for signs of liver injury in patients taking troglitazone.
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