Ceftriaxone-associated gallbladder pseudolithiasis

Ceftriaxone-associated gallbladder pseudolithiasis is a not uncommon complication of this common antibiotic, where a ceftriaxone-calcium precipitate forms gallbladder sludge. It appears more common in pediatric patients. 

Epidemiology

In one series, 25% of pediatric patients developed gallbladder pseudolithiasis whilst receiving ceftriaxone ¹. 

Clinical presentation

Most patients are asymptomatic, although some may develop cholelithiasis, cholecystitis, cholangitis and/or pancreatitis ^2,3. 

Pathology

Approximately 40% of ceftriaxone is excreted into the biliary system, and ceftriaxone can concentrate in the gallbladder and can participate with calcium resulting in the formation of a ceftriaxone-calcium complex ^2,3.

Radiographic features

Ultrasound

Sludge appearing as a hyperechoic layer without posterior acoustic shadowing ². 

Treatment and prognosis

This phenomenon is may be fully reversible, taking between 2 and 63 days to resolve post cessation of treatment ². Ceftriaxone can be a cause of gallstone formation.