TROGLITAZONE-INDUCED HEPATIC-FAILURE LEADING TO LIVER-TRANSPLANTATION- A CASE-REPORT

Background: Troglitazone is a new drug for the treatment of type 2 dia betes. 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 resul ted in death or liver transplantation. Objective: To report the clinic al and histopathologic characteristics of a patient with troglitazone- associated severe liver injury leading to transplantation. Design: Cas e report. Setting: Two university hospitals. Patient: A 55-year-old wo man taking troglitazone, 400 mg/d, and insulin, 120 U/d. Intervention: Discontinuation of troglitazone therapy, pretransplantation liver bio psy, and liver transplantation. Results: Early nonspecific symptoms we re attributed to other causes and were not evaluated. After the patien t had used troglitazone for 3.5 months, massive loss of liver parenchy ma and symptoms of liver failure developed, necessitating liver transp lantation. Conclusion: Troglitazone may cause subfulminant liver failu re.