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[A case report of reversible biliary pseudolithiasis caused by ceftriaxone in childhood: does the problem deserve
G Parisi1, S Rojo, C Mancinelli
1Unità Operativa Pediatrico Neonatologica, Presidio Ospedaliero di Vasto, Regione Abruzzo, Azienda USL Lanciano, Vasto, Chieti.
Insights
A nine-year-old girl developed gallbladder pseudolithiasis during antibiotic treatment with Cefotaxime (CFTX). Symptoms resolved after discontinuing the drug, highlighting the need for vigilance in pediatric patients.
Area of Science:
- Pediatric Pharmacology
- Gastroenterology
- Infectious Diseases
Background:
- Cefotaxime (CFTX) is a third-generation cephalosporin antibiotic commonly used for bacterial infections.
- Gallbladder pseudolithiasis, characterized by gallstone-like imaging findings without actual stones, is a rare adverse effect.
- Pediatric cases of CFTX-associated pseudolithiasis have been reported, sometimes at non-standard therapeutic doses.
Observation:
- A nine-year-old female presented with meningeal irritation and upper airway infection.
- Treatment with Cefotaxime (CFTX) at 50 mg/kg/day (maximum recommended dose) for six days led to symptomatic cholecystic pseudolithiasis.
- The pseudolithiasis resolved two weeks after cessation of CFTX therapy.
Findings:
- This case supports recent reports of gallbladder pseudolithiasis in children associated with Cefotaxime (CFTX).
- The occurrence at recommended doses suggests other contributing factors, potentially including familial predisposition.
- The condition appears reversible upon drug discontinuation.
Implications:
- Highlights the importance of considering Cefotaxime (CFTX) as a potential cause of gallbladder pseudolithiasis in pediatric patients.
- Recommends judicious use of CFTX and vigilance for this adverse event.
- Suggests further investigation into the etiopathogenesis and risk factors, including genetic predisposition.
Abstract:
The authors report the case of a nine-year-old girl admitted to hospital with signs of meningeal irritation during the course of hyperpyretic phlogosis of the upper airways who presented, after 6 days' treatment with CFTX, at a dose of 50 mg/kg/day (1.5 g/day), therefore at the maximum recommended dose for the antibiotic in question, symptomatic cholecystic "pseudolithiasis" which resolved two weeks after the suspension of the drug. This case appears to concord with recent reports of "pseudolithiasis" in childhood that appeared with doses not regarded as being at risk, and it draws attention to the etiopathogenetic importance of other factors, including familial recurrence. The authors recommend a reasonable use of CFTX and the need to be "vigilant" both in relation to the onset and evolution of the clinical condition described above.