Ceftriaxone-associated pancreatitis captured on serial computed tomography scans

Area of Science:

• Gastroenterology and Hepatology
• Radiology
• Pharmacology

Background:

• Ceftriaxone, a third-generation cephalosporin antibiotic, is widely used for bacterial infections.
• Gallbladder sludge and common bile duct stones are common causes of abdominal pain.
• Pseudolithiasis, or false gallstones, can mimic true gallstones on imaging.

Observation:

• A 74-year-old male developed epigastric pain after a 5-day course of ceftriaxone.
• Serial computed tomography (CT) scans were performed before and during symptom onset.
• Initial CT showed no biliary abnormalities; subsequent scans revealed gallbladder sludge and common bile duct (CBD) stones.

Findings:

• The patient presented with epigastric pain, clinically suggestive of biliary colic.
• CT imaging demonstrated the development of dense, radiopaque material within the gallbladder and common bile duct.
• The common bile duct stones and pancreatic head enlargement were identified as the cause of symptoms.

Implications:

• This case highlights a rare adverse effect of ceftriaxone, leading to pseudolithiasis.
• Radiologists and clinicians should consider drug-induced pseudolithiasis in patients with unexplained biliary symptoms after ceftriaxone administration.
• Further investigation into the mechanism of ceftriaxone-induced pseudolithiasis is warranted.