Pioglitazone-Induced Acute Rhabdomyolysis

ioglitazone, a peroxisome proliferator-activated receptor ␥ agonist, is a relatively new oral antidiabetes agent.It has been shown to decrease insulin resistance in patients with type 2 diabetes, resulting in lowered blood glucose concentrations and A1C values.It can be used alone or in combination with metformin or a sulfonylurea.The adverse effects of pioglitazone include weight gain, headache, and edema.We report here a case of a patient who developed severe acute rhabdomyolysis after receiving pioglitazone.A 52-yearold man had a 2-year history of type 2 diabetes that was treated with gliclazide (60 mg/day).Six weeks after addition for pioglitazone (15 mg/day), the patient was admitted to hospital for 4 days for myalgia and severe muscle weakness.He had no recent viral illness or other complaints.He denied any change from his normal level of activity.No alcohol ingestion, illicit drugs, unprescribed medication use, or trauma was present.A physical examination revealed severe proximal muscle weakness and tenderness affecting all four limbs.Laboratory tests showed marked increases in the serum creatinine phosphokinase (9,851 IU/l [normal limit 150 IU/l]), serum myoglobin, and aspartate aminotransferase (98 IU/l) levels.His creatinine serum level was normal at 60 mol/l.There were no signs of severe hyperglycemia, diabetic ketoacidosis, hypokalemia, or hypophosphatemia.Autoantibody screening and viral serologies were negative.Thyroid function was normal.Electromyography