Ceftriaxone-Associated Cholelithiasis in a Premature Toddler From Ethiopia: A Case Report

Ceftriaxone-associated cholelithiasis is an uncommon but well-recognized adverse effect in pediatric patients, resulting from precipitation of ceftriaxone-calcium complexes within bile. Although often asymptomatic and transient, its radiologic appearance may mimic true gallstones and lead to unnecessary surgical intervention. We report a 2-year-old male child, born prematurely at 34 weeks of gestation, who was incidentally diagnosed with gallbladder stones during follow-up evaluation after multiple hospital admissions for dehydration and presumed infections treated with high-dose intravenous ceftriaxone. The child was asymptomatic for biliary disease, with normal physical examination and laboratory findings. Abdominal ultrasonography demonstrated multiple mobile echogenic foci with posterior acoustic shadowing, the largest measuring 1.1 cm, without evidence of inflammation or biliary obstruction. Given the absence of symptoms and identifiable hemolytic or metabolic disorders, conservative management with close follow-up was adopted. Repeat ultrasonography after 12 weeks showed complete spontaneous resolution of the gallstones. This case highlights the importance of recognizing ceftriaxone-associated cholelithiasis in young children to help avoid unnecessary surgical intervention in appropriately selected asymptomatic patients through appropriate conservative management.