A symptomatic child with ceftriaxone-associated biliary pseudolithiasis

Abstract

A 5-year-old boy who had pneumonia was treated in a neighboring hospital. Ceftriaxone was administrated 2 g/day divided into two equal intravenous doses. After 1 week of ceftriaxone therapy, the patient developed abdominal pain. In our hospital, an abdominal sonogram showed a hyperechoic band with postacoustic shadow within the collapsed gallbladder. He was diagnosed with ceftriaxone-associated biliary pseudolithiasis, and ceftriaxone therapy was ceased. On the 8th our hospital day, he again complained of right abdominal pain after supper. A sonogram revealed high-amplitude echoes within the gallbladder neck and common bile duct. Furthermore, bile duct dilatation was observed. He was managed conservatively, after which the symptoms were resolved. On the 11th day, a sonogram showed only sludge within the gallbladder, and on the 13th day, he was discharged from our hospital. It is important for sonographers to recognize the possible occurrence of biliary pseudolithiasis in ceftriaxone-treated patients, especially when a high dose is used in children.

Ceftriaxone Administration Associated with Lithiasis in Children: Guilty or Not? A Systematic Review

“…Abdominal pain, fever, a positive Murphy's sign, and vomiting frequently occurred between the fourth and seventh day after administration [30,32,33,43]. Abdominal pain was reported to initiate even after the discontinuation of ceftriaxone [38].…”

“…The detection time of lithiasis using ultrasound is reported to be between 10-20 days [12,25,27]. However, there are studies that report a diagnosis time of less than a week [26,31,32,34,35,37]. Cholelithiasis was detected even after 35 h [18].…”

Adverse reaction to ceftriaxone in a 28-day-old infant undergoing urgent craniotomy due to epidural hematoma: review of neonatal biliary pseudolithiasis

“… 15 , 17 In current practice, due to increased use of radiological imaging such as ultrasonography in neonatal and pediatric intensive care units this condition can be diagnosed more often. 18 – 20 These diagnostic methods have contributed to an increased detection rate of this phenomenon, even in the youngest patients in pediatric intensive care unit, who may be asymptomatic.…”