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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
PubMed

Insights

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.
Keywords:
RUCAM (2016)case reportdrug‐induced liver injurymeropenemmixed liver injuryupdated RUCAM

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