Meropenem-Induced Acute Liver Injury in a Pediatric Patient with Severe Combined Immunodeficiency: A Case Report

Abstract Meropenem, a broad-spectrum carbapenem antibiotic, is vital for treating multidrug-resistant (MDR) bacterial infections, particularly in immunocompromised patients. While hepatotoxicity is rare, it poses a significant risk in vulnerable populations. This report describes the case of an 8-year-old male with severe combined immunodeficiency (SCID) and major histocompatibility complex class II deficiency, who developed acute liver injury during meropenem therapy for MDR Salmonella enterica gastroenteritis. Liver enzyme elevations persisted beyond infection resolution but normalized post-cessation of meropenem, with extensive workups ruling out alternative causes. This novel case, the first reported in SCID, underscores the need for proactive liver function test monitoring in immunocompromised pediatric patients and highlights gaps in understanding pediatric-specific drug-induced liver injury mechanisms, advocating for tailored antibiotic stewardship and further research.