Ceftriaxone-associated gallbladder pseudolithiasis
Citation, DOI & article data
- Ceftriaxone-associated biliary 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.
On this page:
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 precipitate 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 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.
References
- 1. Papadopoulou F, Efremidis S, Karyda S, Badouraki M, Karatza E, Panteliadis C, Malaka K. Incidence of ceftriaxone-associated gallbladder pseudolithiasis. (1999) Acta paediatrica (Oslo, Norway : 1992). 88 (12): 1352-5. Pubmed
- 2. Choi YY, Jung YH, Choi SM, Lee CS, Kim D, Hur KY. Gallbladder pseudolithiasis caused by ceftriaxone in young adult. (2011) Journal of the Korean Surgical Society. 81 (6): 423-6. doi:10.4174/jkss.2011.81.6.423 - Pubmed
- 3. Aditi Nayak, Adam Slivka. Ceftriaxone-Induced Gallstones: Case Report and Literature Review. (2014) ACG Case Reports Journal. 1 (3): 170. doi:10.14309/crj.2014.40 - Pubmed
Related articles: Pathology: Hepato-Pancreato-Biliary
- liver
- depositional disorders
- infection and inflammation
- liver abscess
- hepatic hydatid infection
- cirrhosis
- hepatitis
- cholecystitis
- cholangitis
- malignancy
- liver and intrahepatic bile duct tumors
- benign epithelial tumors
- hepatocellular hyperplasia
- hepatocellular adenoma
- hepatic/biliary cysts
- benign nonepithelial tumors
- primary malignant epithelial tumors
- hepatocellular carcinoma
- hepatocellular carcinoma variants
-
cholangiocarcinoma
- intra-hepatic
- mass-forming type
- periductal infiltrating type - Klatskin tumors
- intraductal growing type
- extra-hepatic/large duct type
- intra-hepatic
- biliary cystadenocarcinoma
- combined hepatocellular and cholangiocarcinoma
- hepatoblastoma
- undifferentiated carcinoma
- primary malignant nonepithelial tumors
- hematopoietic and lymphoid tumors
- primary hepatic lymphoma
- hepatic myeloid sarcoma (hepatic chloroma)
- secondary tumors
- miscellaneous
- adrenal rest tumors
- hepatic carcinosarcoma
- hepatic fibroma
- hepatic hemangioma
- hepatic Kaposi sarcoma
- hepatic lipoma
- hepatic mesenchymal hamartoma
- hepatic myxoma
- hepatic rhabdoid tumor
- hepatic solitary fibrous tumor
- hepatic teratoma
- hepatic yolk sac tumor
- inflammatory myofibroblastic tumor (inflammatory pseudotumor)
- nodular regenerative hyperplasia
- pancreatic rest tumors
- primary hepatic carcinoid
- benign epithelial tumors
- liver and intrahepatic bile duct tumors
- metabolic
- trauma
-
vascular and perfusion disorders
- portal vein related
- hepatic artery related
- hepatic veins related
- inferior vena cava related
- other
- third inflow
- liver thrombotic angiitis
- infra diaphragmatic total anomalous pulmonary venous return (TAPVR)
- hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease)
- pancreas
-
pancreatic neoplasms
- cystic neoplasm (cystic pancreatic mass differential diagnosis)
- solid neoplasm
- non-epithelial pancreatic neoplasms
- others
- simple pancreatic cyst
-
pancreatitis (mnemonic for the causes)
- acute pancreatitis
- chronic pancreatitis
- Ascaris-induced pancreatitis
- tropical pancreatitis
- autoimmune pancreatitis
- emphysematous pancreatitis
- hypertriglyceridemia-induced pancreatitis
- hereditary pancreatitis
- pancreatitis associated with cystic fibrosis
- pancreaticopleural fistula
- segmental pancreatitis
- pancreatic atrophy
- pancreatic lipomatosis
- pancreatic trauma
- pancreatic transplant
-
pancreatic neoplasms
- gallbladder and biliary
- congenital malformations and anatomical variants
- gallstones
- gallbladder inflammation
- bile ducts inflammation
- gallbladder wall abnormalities
- other gallbladder abnormalities
- bile duct dilatation (differential)
- bile duct wall thickening (differential)
- bile ducts neoplasms