Ceftriaxone-Associated Severe Acute Hepatitis

Area of Science:

• Hepatology
• Pharmacology
• Infectious Diseases

Background:

• Drug-induced liver injury (DILI) represents a significant clinical challenge.
• Ceftriaxone is a commonly prescribed parenteral antibiotic known for its broad-spectrum activity and generally favorable safety profile.
• Understanding potential rare adverse reactions is crucial for patient safety.

Observation:

• A patient presented with severe acute hepatitis after receiving a single 2g dose of ceftriaxone.
• The patient experienced fever (101.9 F) but had no other identifiable cause for the acute hepatocellular injury.
• Clinical improvement and normalization of liver enzymes were observed within one week of ceasing ceftriaxone administration.

Findings:

• The case suggests a probable link between a single ceftriaxone dose and severe acute hepatitis.
• The Roussel Uclaf Causality Assessment Method (RUCAM) score of 6 indicated DILI as the likely cause.
• This event underscores a rare potential side effect of ceftriaxone.

Implications:

• This case highlights the importance of considering ceftriaxone as a potential cause of DILI, even after a single dose.
• Further large-scale surveillance is warranted to establish the incidence and characteristics of this rare adverse effect.
• Clinicians should maintain vigilance for potential hepatotoxicity when prescribing ceftriaxone, especially in cases of unexplained liver enzyme elevation.