Glimepiride-induced cholestasis in a man with diabetes mellitus: a case report

INTRODUCTION: There has been a progressive increase in the incidence of type II diabetes mellitus cases over the past decade. The availability of a wide variety of oral hypoglycemics has given rise to a number of adverse effects. In this case report, we describe the case of a patient recently diagnosed with type II diabetes. He was receiving treatment with glimepiride and experienced rapid onset of cholestatic liver injury as a side effect, which reversed upon cessation of therapy. CASE PRESENTATION: We present the case of a 58-year-old Egyptian man with a recent diagnosis of type II diabetes mellitus. He presented with a clinical picture of progressive jaundice three days before admission. Laboratory investigations revealed elevated bilirubin, alkaline phosphatase and gamma glutamyl transferase levels. Ultrasonography revealed intrahepatic biliary duct dilatation and two small lymph nodes in the porta hepatis; there was, however, no extrahepatic biliary duct dilatation or stones in the gall bladder. Abdominal computed tomography excluded pancreatic or hepatic focal lesions, but the tumor marker CA19-9 was elevated. The progressive improvement in the patient's symptomatology and laboratory investigations after admission argued against malignancy. A thorough and detailed history revealed that the patient had started on a new medication, glimepiride, five months earlier for the treatment of diabetes mellitus and an improvement was noted after discontinuation of this oral hypoglycemic and the introduction of insulin therapy to control his blood sugar. CONCLUSION: Drugs are an important, often unrecognized, cause of acute cholestasis. Among the rare causes responsible for this complication is the sulfonylurea glimepiride. A thorough drug history is therefore helpful in any case of unexplained cholestasis.