Drug-Induced Liver Injury Secondary to Meropenem: Diagnostic Challenge and Therapeutic Role of Hemoadsorption

Meropenem is a broad-spectrum carbapenem antibiotic commonly used in critically ill patients. While generally considered safe, rare cases of drug-induced liver injury (DILI) have been reported. We describe a case of intrahepatic cholestatic hepatitis attributed to meropenem in an intensive care unit (ICU) patient, with histologic confirmation and clinical improvement following hemoadsorption therapy. A 65-year-old man was admitted to the ICU following a fall from height, sustaining multiple traumatic injuries, including spinal cord trauma with neurogenic shock. He developed pneumonia requiring escalation to meropenem. Five days into therapy, progressive cholestasis and hyperbilirubinemia developed, despite no biliary obstruction on imaging. Meropenem was discontinued on day 12 of treatment. Liver function continued to deteriorate, culminating in hepatic encephalopathy. Hemoadsorption therapy (HA-380 cartridge) was initiated with clinical and biochemical improvement. Liver biopsy confirmed intrahepatic cholestatic hepatitis consistent with DILI. After recurrence of symptoms and worsening cholestasis, hemoadsorption was restarted with resolution of pruritus and improved liver function. Meropenem-induced liver injury is rare and usually self-limiting. In our patient, liver injury followed a cholestatic pattern, confirmed histologically, and likely represented an idiosyncratic reaction. The recurrence of liver dysfunction upon cessation of hemoadsorption and subsequent response to therapy suggests a possible therapeutic role of hemoadsorption in managing hyperbilirubinemia and cholestatic symptoms in DILI. This case highlights a rare but severe presentation of meropenem-induced cholestatic hepatitis in a critically ill patient. Hemoadsorption may be a valuable adjunctive therapy in select cases of DILI with significant bilirubin elevation and pruritus. Clinicians should maintain a high index of suspicion for DILI in ICU patients receiving broad-spectrum antibiotics.