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A symptomatic child with ceftriaxone-associated biliary pseudolithiasis.

Naoki Kutuya1, Yutaka Ozaki2, Tadaharu Okazaki3

  • 1Department of Radiology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. hollyhock22@hotmail.com.

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Summary

Ceftriaxone, an antibiotic, can cause biliary pseudolithiasis (false gallstones) in children, leading to abdominal pain. Early recognition and cessation of the drug are crucial for symptom resolution.

Keywords:
biliary pseudolithiasisceftriaxonechildultrasonography

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Area of Science:

  • Pediatric Gastroenterology
  • Pharmacology
  • Medical Imaging

Background:

  • Ceftriaxone is a commonly used antibiotic in pediatric patients.
  • Biliary pseudolithiasis is a rare adverse effect associated with certain medications.
  • Pediatric abdominal pain can have various etiologies, requiring careful diagnostic evaluation.

Purpose of the Study:

  • To report a case of ceftriaxone-associated biliary pseudolithiasis in a pediatric patient.
  • To highlight the importance of recognizing this adverse drug reaction in children.
  • To emphasize the role of ultrasonography in diagnosing biliary pseudolithiasis.

Main Methods:

  • A case report of a 5-year-old boy treated with high-dose intravenous ceftriaxone for pneumonia.
  • Clinical presentation of abdominal pain following antibiotic administration.
  • Diagnostic imaging using abdominal sonography (ultrasound) to evaluate the gallbladder and biliary tree.
  • Conservative management of symptoms and monitoring of gallbladder findings.

Main Results:

  • The patient developed abdominal pain and was diagnosed with ceftriaxone-associated biliary pseudolithiasis.
  • Abdominal sonograms revealed characteristic findings of biliary pseudolithiasis, including hyperechoic bands and sludge.
  • Cessation of ceftriaxone therapy led to symptom resolution.
  • Biliary findings normalized over time with conservative management.

Conclusions:

  • Ceftriaxone, particularly at high doses in children, can induce biliary pseudolithiasis.
  • Sonographers should be aware of this potential adverse effect when evaluating pediatric patients on ceftriaxone.
  • Prompt recognition and drug discontinuation are key to managing ceftriaxone-induced biliary pseudolithiasis.