We report 2 cases of pulmonary edema associated with the use of troglitazone (Rezulin; Parke-Davis, Morris Plains, NJ).
A 65-year-old woman with type 2 diabetes began troglitazone therapy. Her hemoglobin A1c fraction improved from 0.10 to 0.06. After 8 months of therapy, she reported lower-extremity edema, which became severe. The findings of her physical examination were otherwise unremarkable, and there was no proteinuria. Furosemide therapy was initiated, but the edema progressed. After 13 months, she had shortness of breath and orthopnea. Details are noted in Table 1. A chest x-ray film showed pulmonary edema. An electrocardiogram and an adenosine stress test with a tetrofosmin perfusion scan revealed no abnormalities. A gated blood pool sample showed an ejection fraction of 0.62, with a normal left ventricle. After the troglitazone therapy was discontinued, the patient's fluid overload improved, and she lost 7.1 kg after 3 weeks.
Hirsch IB, Kelly J, Cooper S. Pulmonary Edema Associated With Troglitazone Therapy. Arch Intern Med. 1999;159(15):1811-1817. doi: