QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Résumé Extracto Full Text PDF Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Articles Ahead of Print [Order Reprint] Google Scholar Articles by El-Naggar, M. H. Articles by Habib, B. PubMed PubMed Citation Articles by El-Naggar, M. H. Articles by Habib, B.

Late-Onset Rosiglitazone-Associated Acute Liver Failure in a Patient with Hodgkin's Lymphoma

Assistant Consultant, Section of Internal Medicine, Department of Medicine, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia

Ahmed Helmy, MD MSc PhD

Assistant Consultant Gastroenterologist, Department of Medicine, King Faisal Specialist Hospital & Research Center; Lecturer and Consultant Gastroenterologist, Department of Gastroenterology & Tropical Medicine, Faculty of Medicine & Assiut University Hospital, Assiut, Egypt

Mahmoud Moawad, MD MPh FACP

Consultant Internal Medicine, Section of Internal Medicine, Department of Medicine, King Faisal Specialist Hospital & Research Center

Mohamed Al-Omary, MD

Consultant Pathologist, Department of Pathology, King Faisal Specialist Hospital & Research Center

Yusuf Al-Kadhi, MD FCCR

Consultant Radiologist, Department of Radiology, King Faisal Specialist Hospital & Research Center

Bassil Habib, MD FACP

Consultant, Internal Medicine, Section of Internal Medicine, Department of Medicine, King Faisal Specialist Hospital & Research Center

Reprints: Dr. Helmy, Section of Gastroenterology, Department of Medicine, MBC: 46, King Faisal Specialist Hospital & Research Center, PO Box 3354, Riyadh 11211, Saudi Arabia, fax +966 1 442 7499, ahsalem10{at}hotmail.com

OBJECTIVE: To report a case of rosiglitazone-associated hepatotoxicity in a patient with Hodgkin's lymphoma.

CASE SUMMARY: A 52-year-old man presented with low-grade fever and fatigue that had been present for 4 months. He had been receiving insulin for 5 years and rosiglitazone 4 mg/day for 11 months for control of type 2 diabetes; he was receiving no other drug therapy. During hospitalization, hepatotoxicity was shown, with abnormal liver function test results including alanine aminotransferase 488 U/L, aspartate aminotransferase 344 U/L, alkaline phosphatase 832 U/L, total bilirubin 4.61 mg/dL, and direct bilirubin 3.63 mg/dL. Rosiglitazone was discontinued after further elevation of bilirubin (total 14.67 mg/dL, direct 12.10 mg/dL) occurred. Other causes for hepatotoxicity were ruled out. Hodgkin's lymphoma was diagnosed during the workup; however, liver imaging and biopsy also excluded this as the direct cause of acute liver failure. Despite discontinuation of rosiglitazone, the bilirubin level continued to increase to 49.29 mg/dL (direct >20 mg/dL).The patient died 3 months after admission.

DISCUSSION: Rosiglitazone maleate is a thiazolidinedione approved for treatment of type 2 diabetes mellitus. The first member of this drug class, troglitazone, was withdrawn from the market due to reports of acute liver failure. Rosiglitazone has been shown to be much safer than troglitazone, despite some reported cases of early-onset nonfatal hepatotoxicity. Use of the Naranjo probability scale indicated that rosiglitazone was the probable cause of acute liver failure in our patient.

CONCLUSIONS: We conclude that rosiglitazone may be associated with late-onset acute liver failure. Clinicians should be aware of such a complication and monitor liver function in patients receiving the drug.

Key Words: drug-induced hepatitis, fulminant hepatic failure, thiazolidinediones

Published Online, April 8, 2008. www.theannals.com, DOI 10.1345/aph.1K543