Ceftriaxone-induced cholestatic hepatitis in a child: A case report and a review of the literature

Abstract

Ceftriaxone, a third-generation cephalosporin, is commonly used in pediatric patients and is generally well tolerated. Its more frequent adverse effects are biliary pseudolithiasis, urolithiasis, and hemolytic anemia. On the other hand, ceftriaxone-induced acute cholestatic hepatitis is a very rare condition, especially in children. Here, we describe a case of this condition in a young male child to highlight the importance of suspecting this drug-induced liver injury to achieve a prompt diagnosis.

Ceftriaxone-induced severe hemolytic anemia, renal calculi, and cholecystolithiasis in a 3-year-old child: a case report and literature review

“…It is noteworthy that the transaminase levels peaked following the formation of gallstones. In a recent case reported by Castellazzi et al showed that a 5-year-old child exhibited ceftriaxone-induced acute cholestatic hepatitis with marked elevations in ALT and GGT levels (Castellazzi et al, 2022). Bile acids trigger a hepatic inflammatory response, causing cholestatic liver injury (Zhang et al, 2023b).…”

“…The majority of adverse reactions caused by ceftriaxone are relatively mild, such as gastrointestinal hepatobiliary disorders (Zeng et al, 2020). Less common ADRs include kidney injury (Zhang et al, 2023a), ceftriaxone-induced cholestatic hepatitis (Castellazzi et al, 2022;Eldougdoug et al, 2023), hemolytic anemia (Northrop and Agarwal, 2015), and lithiasis (Louta et al, 2023). However, in very rare cases, it can lead to serious ADRs, such as hemolysis crisis, renal failure, multiple organ failure (Bell et al, 2005) and even death (Van Buren et al, 2018).…”