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Two Cases of Severe Clinical and Histologic Hepatotoxicity Associated with Troglitazone

Norman Gitlin, MD; Neil L. Julie, MD; Charles L. Spurr, MD; Kie N. Lim, MD; and Herbert M. Juarbe, MD
[+] Article and Author Information

From Emory University School of Medicine and Shady Grove Adventist Hospital, Atlanta, Georgia. Requests for Reprints: Norman Gitlin, MD, Emory University School of Medicine, Division of Digestive Diseases, WMB 2101, Pierce Drive, Atlanta, GA 30322. Current Author Addresses: Drs. Gitlin and Lin: Emory University School of Medicine, Division of Digestive Diseases, WMB 2101, Pierce Drive, Atlanta, GA 30322.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1998;129(1):36-38. doi:10.7326/0003-4819-129-1-199807010-00008
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Several oral antihyperglycemic agents are available for management of type 2 diabetes. These agents generally fall into the chemical or function groups sulfonylureas, biguanides, or α-glucosidase inhibitors. Recently, the U.S. Food and Drug Administration approved troglitazone (Rezulin, Parke-Davis, Morris Plains, New Jersey), a thiazolidinedione agent that is unrelated to the aforementioned categories, as a novel oral antihyperglycemic agent. It decreases hepatic glucose output and increases insulin-dependent glucose metabolism in skeletal muscle [12]. It is not an insulin secretagogue. We report two patients who had severe hepatotoxicity associated with troglitazone administration.

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Grahic Jump Location
Figure 1.
Low-power view of portal tract showing interface hepatitis, mild inflammatory infiltrate, bile duct reduplication, and necrotic hepatocytes (hematoxylin-eosin stain; original magnification, x96).
Grahic Jump Location

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