Ceftriaxone-associated gallbladder pseudolithiasis
Citation, DOI, disclosures and article data
At the time the article was created Henry Knipe had no recorded disclosures.
View Henry Knipe's current disclosuresAt the time the article was last revised Daniel J Bell had no financial relationships to ineligible companies to disclose.
View Daniel J Bell's current disclosures- Ceftriaxone-associated biliary pseudolithiasis
- Ceftriaxone-induced biliary pseudolithiasis
- Drug-induced 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.
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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.
Other drugs have also been implicated as causes of pseudolithiasis including furosemide, clofibrate, octreotide, cyclosporine, erythromycin, and ampicillin 4.
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
- 4. Gomes F, Costeira F, Leite C, Silva P. Ceftriaxone-Induced Acute Cholecystitis. J Med Ultrasound. 2021;29(4):288. doi:10.4103/jmu.jmu_132_20 - Pubmed
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