Gliclazide-induced acute hepatitis

There are few reports in the literature related to sulfonylurea-induced hep atotoxicity. We describe the case of acute hepatitis induced by gliclazide, a second generation sulfonylurea. A 60-year-old woman with diabetes mellit us (type 2) developed an acute icteric hepatitis-like illness 6 weeks after the initiation of gliclazide therapy. Other causes of acute hepatocellular necrosis were excluded. Liver histology showed marked portal inflammation with lymphocytes, monocytes and eosinophils, associated with lobular inflam mation (indicative of a histological pattern consistent with drug-induced h epatitis). The drug was immediately withdrawn and the patient was given gli benclamide. The patient recovered clinically and, in less than 4 weeks, her serum bilirubin and aminotransferases returned to normal levels. We believ e that this is the first description of acute hepatitis caused by an idiosy ncratic adverse reaction to gliclazide or to one of its metabolites. In con clusion, this case strongly suggests that gliclazide can induce acute icter ic liver necro-inflammation which may be misdiagnosed clinically as acute v iral hepatitis. In patients who show abnormal liver function tests, the imm ediate discontinuation of gliclazide is recommended. (C) 2000 Lippincott Wi lliams & Wilkins.