Mixed hepatocellular-cholestatic liver injury after pioglitazone therapy

Background: Ploglitazone 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.