Ceftriaxone-Associated Gallbladder Pseudolithiasis in a Pediatric Patient, Case Report and Review of the Literature

Abstract

Ceftriaxone plays a vital role in modern medicine due to its broad-spectrum coverage of common microbes. A relatively frequent, yet underplayed side effect is pseudolithiasis, especially in the pediatric setting. While most cases resolve spontaneously, there have been reports of patients requiring surgical treatment after developing further complications. We report a case of an abrupt onset (<3 days) pseudolithiasis occurring after just four moderate doses of Ceftriaxone. A previously healthy 2 years and 9-month-old girl was admitted as a case of exudative tonsillitis with secondary gastroenteritis. On day three of Ceftriaxone treatment, sudden onset severe abdominal pain ensued which warranted an abdominal ultrasound showing multiple gallbladder stones. Consequently, Ceftriaxone was changed to Cefotaxime and the pain subsided following a further two inpatient days and outpatient follow-up appointments were scheduled. Ceftriaxone has a high elimination in the bile, which gives predominance for potential biliary complications. It is well documented that high and prolonged doses increase the likelihood of these complications. In our case the accelerated progression of the pseudolithiasis could be due to the dehydration caused by the background gastroenteritis. Reduced oral intake and dehydration causes biliary stasis which accelerates the formation of biliary sludge and gallbladder precipitates due to biliary stasis. In the future, physicians could reconsider the use of ceftriaxone in patients with similar presentations.