Drug-induced hepatitis with severe cholestasis due to voglibose

A case of drug-induced hepatitis with severe cholestasis caused by voglibose, a new agent for treating noninsulin-dependent diabetes mellitus, is described. The patient presented with icterus and pruritis. Voglibose was administered for 3 months before abnormal liver function was detected. The lymphocyte blast transformation test was positive for voglibose (stimulation index = 536%). One month after the onset of icterus, the patient also developed cholangitis due to methicillin-resistant Staphylococcus aureus, and the serum total bilirubin level increased to above 40 mg/dl. He was treated with plasma exchange, but eventually died. Voglibose is only absorbed slightly after oral administration, and there have been no reports of hepatitis due to this drug. This is the first fatal case of voglibose-induced hepatitis combined with methicillin-resistant Staphylococcus aureus cholangitis.