Drug-Induced Cholestasis Secondary to Meropenem in an Elderly Patient: Report of A Rare Case

Meropenem is a broad-spectrum carbapenem antibiotic commonly used in hospitals to treat moderate-to-severe infections. Although rare, meropenem can cause drug-induced liver disease, including mild transaminase elevation, cholestasis, or hepatic failure. This report presents an 80-year-old woman admitted after a mechanical fall and diagnosed with a catheter-associated urinary tract infection. Intravenous meropenem was initiated following urine culture confirmation of Citrobacter koseri in the context of worsening confusion and elevated inflammatory markers. Six days after starting meropenem, the patient developed generalised weakness and mild pruritus. Liver function tests showed significant abnormalities: alkaline phosphatase (ALP) 1450 U/L and alanine transaminase (ALT) 415 U/L. Liver function improved after meropenem was discontinued. The pattern of injury was consistent with cholestatic drug-induced liver injury (DILI) (R-value = 1), and an updated Roussel Uclaf Causality Assessment Method (RUCAM) score of 8 indicated a probable causal relationship with meropenem. This case highlights the importance of considering DILI, even with short-term antibiotic use, especially in elderly patients. Routine monitoring of liver function is recommended for those receiving meropenem. Early recognition and prompt withdrawal of the offending agent are essential for clinical improvement and prevention of complications.