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Meropenem-Induced Possible Mixed Drug-Induced Liver Injury With Cholestatic Evolution: A Case Report Evaluated Using
Nidal Mutawodeh1, Sarah Saife1, Akram Shalaby2
1Department of Medicine, Faculty of Medicine and Health Sciences An-Najah National University Nablus Palestine.
Clinical Case Reports
|June 8, 2026
Summary
This case study highlights a rare instance of drug-induced liver injury (DILI) linked to meropenem, a typically safe antibiotic. It emphasizes systematic causality assessment for accurate diagnosis and management of meropenem-associated DILI.
Area of Science:
- Hepatology
- Pharmacology
- Clinical Medicine
Background:
- Drug-induced liver injury (DILI) is a diagnosis of exclusion requiring careful causality assessment.
- Meropenem is generally considered safe for the liver, but rare idiosyncratic DILI cases have been documented.
Purpose of the Study:
- To report a case of DILI in a patient exposed to meropenem.
- To illustrate the diagnostic process and causality assessment for meropenem-induced liver injury.
Main Methods:
- A 33-year-old female presented with elevated liver tests after meropenem exposure.
- Liver injury pattern was assessed using R-value calculation (mixed evolving to cholestatic).
- Causality was evaluated using the updated Roussel Uclaf Causality Assessment Method (RUCAM).
Main Results:
- The patient exhibited progressive liver test abnormalities following meropenem administration.
- Imaging, endoscopy, and serology ruled out other causes of liver injury.
- RUCAM score of 4 indicated possible DILI attributed to meropenem.
Conclusions:
- This case expands the known spectrum of meropenem-associated DILI.
- Highlights the importance of early R-value calculation and RUCAM assessment.
- Underscores the need for prompt meropenem withdrawal in suspected DILI cases.
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