1.   Piroxicam may induce submassive necrosis of the liver, probably as an idiosyncratic reaction.

2.   The appearances were consistent with submassive necrosis caused by drug toxicity.

3.   Necropsy was performed and showed a small liver with light microscopic changes of submassive necrosis.

4.   Histology showed submassive necrosis.

5.   We believe that the submassive necrosis in these two patients was caused by piroxicam.

6.   Metabolic and infectious causes of submassive necrosis are unlikely in view of the negative biochemical and serological tests.

7.   Previous case reports of piroxicam induced submassive necrosis have described the onset of jaundice three days and three weeks after beginning piroxicam.

8.   We recommend liver transplantation as the only treatment likely to be successful in drug related submassive necrosis of the liver.