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Granulomatous hepatitis has many causes. Drugs are an important etiologic factor. Several oral hypoglycemic agents are available for treatment of type II diabetes. Rosiglitazone, a thiazolidinedione, is a newer agent in this class. It has not been shown to be hepatotoxic in the premarketing trials. However, a few case reports have implicated it as a cause of acute hepatocellular injury. The authors report a case of granulomatous hepatitis associated with use of rosiglitazone. Liver function tests should be done regularly to monitor patients on this medication.

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Clinicians should be aware of amoxicillin/clavulanate as a drug capable of causing hepatitis with eventual systemic dysfunction. While recovery is usually complete following withdrawal of the drug, in patients with rash associated with hepatic dysfunction, renal insufficiency, or other unusual symptoms, earlier consideration of initiating systemic steroids or liver transplantation referral, in hopes of avoiding progressive systemic response, might be worthwhile.

Clinical characteristics, echocardiographic and Doppler echocardiographic findings, as well as serum levels of chromogranin A were recorded on 62 patients (27 women, 35 men; mean age 55 [11-83] years) with histologically confirmed tumours of the gastroenteropancreatic (GEP) system. Changes in the right heart were found in 14 patients (22%), club-like thickening of tricuspid leaflets in 13, tricuspid regurgitation in 14, stenosis in 2 and right atrial or right ventricular dilatation in 11 and 5, respectively. There was no difference between the patients with or without right-heart changes in regard to age, presence of carcinoid syndrome, duration of symptoms, primary tumour site, pattern of metastases, treatment or chromogranin A level. Two patients with nonfunctioning tumours had right-heart changes. While clinical and biochemical parameters did not identify patients with right-heart changes, echocardiography demonstrated all haemodynamically significant endocardial changes. Even patients with nonfunctioning GEP tumours should be regularly monitored by echocardiography.

The use of nonsteroidal anti-inflammatory drugs (NSAIDs) is extensive, and the upper gastrointestinal (GI) side effects of these drugs have been well recognized. Although much attention has been focused on gastroduodenal ulceration and attendant complications, it is becoming more apparent that NSAIDs exert potentially important effects on the small bowel and colon. The widespread effects of NSAIDs on the GI system, including theories of pathogenesis, will be presented here.

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