Ceftriaxone-induced gallbladder pseudolithiasis in a child: A question of confirmation?

Ceftriaxone is a commonly prescribed antibiotic in pediatric medicine, but its association with gallbladder pseudolithiasis is not well-documented. A four-year-old boy was admitted with lobar pneumonia presenting with fever, cough, and abdominal pain. Because of the severity of his pneumonia, which required inpatient management with parenteral antibiotics, the child was started on intravenous ceftriaxone. The patient had no significant past medical or family history and was not on any medications prior to admission. He was started on ceftriaxone, an injectable antibiotic, at a dosage of 60 mg/kg/day after a chest X-ray confirmed lobar pneumonia in the lower left lung. However, more than five days of treatment in hospital following developed gastrointestinal symptoms, including abdominal discomfort, nausea, and constipation, laboratory tests showed mildly elevated liver enzymes (ALT 45 U/L, AST 50 U/L, ALP 150 U/L, total bilirubin 1.5 mg/dL) and CBC of 14,000 cells/mm³ , while hemoglobin and platelets were normal. C-reactive protein was elevated, and electrolytes were within normal limits. An abdominal ultrasound conducted, revealed the presence of multiple echogenic foci in the gallbladder, which is indicative of pseudolithiasis, but no indicators of cholecystitis. Symptoms resolved after discontinued this antibiotic and replaced with another suitable one, with follow-up ultrasound confirming resolution. This case underscores the need for awareness of ceftriaxone's potential side effects, including gallbladder pseudolithiasis in pediatric patients. Further investigation is warranted to elucidate the mechanisms behind this association and to guide clinical practice. • In pediatric patients, gallbladder pseudolithiasis may result from the administration of ceftriaxone. • A case study of a four-year-old who developed biliary complications as a result of infection therapy. • Transient pseudolithiasis was confirmed by ultrasound following ceftriaxone therapy. • Symptomatic relief following the transition to cefepime antibiotic. • Highlights the necessity of monitoring and being aware of the side effects associated with drugs.