| Peer-Reviewed

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

Received: 26 November 2021     Accepted: 15 December 2021     Published: 24 December 2021
Views:       Downloads:
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.

Published in American Journal of Pediatrics (Volume 7, Issue 4)
DOI 10.11648/j.ajp.20210704.18
Page(s) 225-228
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Ceftriaxone, Pseudolithiasis, Gallstones, Cholelithiasis, Children, Cholecystectomy

References
[1] Diehl AK. Epidemiology and natural history of gallstone disease. Gastroenterology Clinics of North America. 1991; 20 (1): 1-19. doi: 10.1016/s0889-8553(21)00531-8.
[2] Mehta S, Lopez ME, Chumpitazi BP, Mazziotti MV, Brandt ML, Fishman DS. Clinical characteristics and risk factors for symptomatic pediatric gallbladder disease. PEDIATRICS. 2011; 129 (1). doi: 10.1542/peds.2011-0579.
[3] Wesdorp I, Bosman D, de Graaff A, Aronson D, van der Blij F, Taminiau J. Clinical presentations and predisposing factors of cholelithiasis and sludge in children. Journal of Pediatric Gastroenterology and Nutrition. 2000; 31 (4): 411-417. doi: 10.1097/00005176-200010000-00015.
[4] Lee CKK, Glenn DJ. Cefotaxime and ceftriaxone use evaluation in Pediatrics. Diagnostic Microbiology and Infectious Disease. 1995; 22 (1-2): 231-233. doi: 10.1016/0732-8893(95)00081-k.
[5] Richards DM, Heel RC, Brogden RN, Speight TM, Avery GS. Ceftriaxone a review of its antibacterial activity, pharmacological properties and therapeutic use. Drugs. 1984; 27 (6): 469-527. doi: 10.2165/00003495-198427060-00001.
[6] Bor, O., Dinleyici, E. C., Kebapci, M., &amp; Aydogdu, S. D. (2004). Ceftriaxone-associated biliary sludge and pseudocholelithiasis during childhood: A prospective study. Pediatrics International, 46 (3), 322–324. https://doi.org/10.1111/j.1328-0867.2004.01884.x.
[7] Biner B, Öner N, Çeltik C, et al. Ceftriaxone-associated biliary pseudolithiasis in children. Journal of Clinical Ultrasound. 2006; 34 (5): 217-222. doi: 10.1002/jcu.20228.
[8] Soysal A, Eraşov K, Akpinar I, Bakir M. Biliary precipitation during ceftriaxone therapy: frequency and risk factors. Turk J Pediatr. 2007; 49 (4): 404-407.
[9] Shiffman ML, Keith FB, Moore EW. Pathogenesis of ceftriaxone-associated biliary sludge. Gastroenterology. 1990; 99 (6): 1772-1778. doi: 10.1016/0016-5085(90)90486-k.
[10] Nayak A, Slivka A. Ceftriaxone-induced gallstones: Case report and literature review. ACG Case Reports Journal. 2014; 1 (3): 170-172. doi: 10.14309/crj.2014.40.
[11] Prince JS, Senac MO. Ceftriaxone-associated nephrolithiasis and biliary pseudolithiasis in a child. Pediatric Radiology. 2003; 33 (9): 648-651. doi: 10.1007/s00247-003-0963-0.
[12] Park HZ, Lee SP, Schy AL. Ceftriaxone-associated gallbladder sludge. Gastroenterology. 1991; 100 (6): 1665-1670. doi: 10.1016/0016-5085(91)90667-a.
[13] Arpacık M, Ceran C, Kaya T, Karadas B, Sarac B, Koyluoğlu G. Effects of ceftriaxone sodium on in vitro gallbladder contractility in Guinea pigs1. Journal of Surgical Research. 2004; 122 (2): 157-161. doi: 10.1016/j.jss.2004.05.020.
[14] Schaad UB, Wedgwood-Krucko J, Tschaeppeler H. Reversible ceftriaxone-associated biliary PSEUDOLITHIASIS in children. The Lancet. 1988; 332 (8625): 1411-1413. doi: 10.1016/s0140-6736(88)90596-x.
[15] Rodríguez Rangel DA, Pinilla Orejarena AP, Bustacara Diaz M, et al. Cálculos biliares asociados al uso de ceftriaxona en Niños. Anales de Pediatría. 2014; 80 (2): 77-80. doi: 10.1016/j.anpedi.2013.04.001.
[16] Becker CD, Fischer RA. Acute cholecystitis caused by ceftriaxone stones in an adult. Case Reports in Medicine. 2009; 2009: 1-2. doi: 10.1155/2009/13245.
[17] Famularo G, Polchi S, De Simone C. Acute cholecystitis and pancreatitis in a patient with biliary sludge associated with the use of ceftriaxone: a rare but potentially severe complication. Ann Ital Med Int. 1999; 14 (3): 202-204.
[18] Maranan MC, Gerber SI, Miller GG. Gallstone pancreatitis caused by Ceftriaxone. The Pediatric Infectious Disease Journal. 1998; 17 (7): 662-663. doi: 10.1097/00006454-199807000-00022.
[19] Zimmermann AE, Katona BG, Jodhka JS, Williams RB. Ceftriaxone-induced acute pancreatitis. Annals of Pharmacotherapy. 1993; 27 (1): 36-37. doi: 10.1177/106002809302700108.
[20] Ito R, Yoshida A, Taguchi K, Enoki Y, Yokoyama Y, Matsumoto K. Experimental verification of factors influencing calcium salt formation based on a survey of the development of ceftriaxone-induced gallstone-related disorder. Journal of Infection and Chemotherapy. 2019; 25 (12): 972-978. doi: 10.1016/j.jiac.2019.05.020.
Cite This Article
  • APA Style

    Hesham Mubarak Abdalla, Mustafa Mohammed Kafaji, Ahmed Essam Khedr, Abdullah Al-Shamrani. (2021). Ceftriaxone-Associated Gallbladder Pseudolithiasis in a Pediatric Patient, Case Report and Review of the Literature. American Journal of Pediatrics, 7(4), 225-228. https://doi.org/10.11648/j.ajp.20210704.18

    Copy | Download

    ACS Style

    Hesham Mubarak Abdalla; Mustafa Mohammed Kafaji; Ahmed Essam Khedr; Abdullah Al-Shamrani. Ceftriaxone-Associated Gallbladder Pseudolithiasis in a Pediatric Patient, Case Report and Review of the Literature. Am. J. Pediatr. 2021, 7(4), 225-228. doi: 10.11648/j.ajp.20210704.18

    Copy | Download

    AMA Style

    Hesham Mubarak Abdalla, Mustafa Mohammed Kafaji, Ahmed Essam Khedr, Abdullah Al-Shamrani. Ceftriaxone-Associated Gallbladder Pseudolithiasis in a Pediatric Patient, Case Report and Review of the Literature. Am J Pediatr. 2021;7(4):225-228. doi: 10.11648/j.ajp.20210704.18

    Copy | Download

  • @article{10.11648/j.ajp.20210704.18,
      author = {Hesham Mubarak Abdalla and Mustafa Mohammed Kafaji and Ahmed Essam Khedr and Abdullah Al-Shamrani},
      title = {Ceftriaxone-Associated Gallbladder Pseudolithiasis in a Pediatric Patient, Case Report and Review of the Literature},
      journal = {American Journal of Pediatrics},
      volume = {7},
      number = {4},
      pages = {225-228},
      doi = {10.11648/j.ajp.20210704.18},
      url = {https://doi.org/10.11648/j.ajp.20210704.18},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20210704.18},
      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.},
     year = {2021}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Ceftriaxone-Associated Gallbladder Pseudolithiasis in a Pediatric Patient, Case Report and Review of the Literature
    AU  - Hesham Mubarak Abdalla
    AU  - Mustafa Mohammed Kafaji
    AU  - Ahmed Essam Khedr
    AU  - Abdullah Al-Shamrani
    Y1  - 2021/12/24
    PY  - 2021
    N1  - https://doi.org/10.11648/j.ajp.20210704.18
    DO  - 10.11648/j.ajp.20210704.18
    T2  - American Journal of Pediatrics
    JF  - American Journal of Pediatrics
    JO  - American Journal of Pediatrics
    SP  - 225
    EP  - 228
    PB  - Science Publishing Group
    SN  - 2472-0909
    UR  - https://doi.org/10.11648/j.ajp.20210704.18
    AB  - 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.
    VL  - 7
    IS  - 4
    ER  - 

    Copy | Download

Author Information
  • College of Medicine, Al-Faisal University, Riyadh, Saudi Arabia

  • College of Medicine, Al-Faisal University, Riyadh, Saudi Arabia

  • College of Medicine, Al-Faisal University, Riyadh, Saudi Arabia

  • Department of Paediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia

  • Sections