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Reversible Ceftriaxone-Induced Pseudolithiasis in an Adult Patient with Maintenance Hemodialysis.

Shima A, Suehiro T, Takii M, Soeda H, Hirakawa M - Case Rep Nephrol Dial (2015)

Bottom Line: Because of the presence of one gallstone and increased gallbladder wall thickness on computed tomography scans, not detected at the onset of pneumonia, the patient was diagnosed with CTRX-induced gallbladder pseudolithiasis.CTRX was discontinued immediately.At 48 days following CTRX withdrawal, the gallstone and thickening of the gallbladder wall had completely resolved.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, Harasanshin Hospital, Fukuoka, Japan.

ABSTRACT
Ceftriaxone (CTRX) is a third-generation cephalosporin widely used for the treatment of bacterial infections in patients with renal disease because of its excretion by both renal and hepatic mechanisms. Biliary pseudolithiasis is a known CTRX-associated complication; however, there have been no studies of this adverse event in adult patients receiving maintenance hemodialysis. Here we report the case of a 79-year-old Japanese woman with end-stage renal disease (ESRD) receiving maintenance hemodialysis who developed CTRX-induced pseudolithiasis. The patient received CTRX for bronchial pneumonia. Fifteen days following CTRX initiation, the patient presented with stomachache. Because of the presence of one gallstone and increased gallbladder wall thickness on computed tomography scans, not detected at the onset of pneumonia, the patient was diagnosed with CTRX-induced gallbladder pseudolithiasis. CTRX was discontinued immediately. At 48 days following CTRX withdrawal, the gallstone and thickening of the gallbladder wall had completely resolved. ESRD may be a risk factor for CTRX-induced pseudolithiasis as hepatic excretion of CTRX is the predominant clearance mechanism in patients with ESRD. More attention should be paid to CTRX-induced pseudolithiasis following the use of CTRX in ESRD patients.

No MeSH data available.


Related in: MedlinePlus

Images from abdominal CT scanning. The white arrows indicate the gallbladder. a The gallbladder was normal in size, shape, and location, and no gallstone was detected just prior to CTRX administration. b A stone in the gallbladder and thickening of the gallbladder wall were detected 13 days following CTRX initiation. c The stone and thickened wall of the gallbladder resolved 48 days following CTRX cessation.
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Figure 1: Images from abdominal CT scanning. The white arrows indicate the gallbladder. a The gallbladder was normal in size, shape, and location, and no gallstone was detected just prior to CTRX administration. b A stone in the gallbladder and thickening of the gallbladder wall were detected 13 days following CTRX initiation. c The stone and thickened wall of the gallbladder resolved 48 days following CTRX cessation.

Mentions: The cough, fever, general fatigue, and laboratory data steadily improved following CTRX administration. The WBC count was 5,300/μl and the CRP level was 1.4 mg/dl on the 11th day after CTRX initiation. However, on the 13th day, she unexpectedly presented with stomachache around the right hypochondrium with a firm, round mass and a slight fever of 37.2°C. The WBC count was 10,560/μl, the CRP level was 8.8 mg/dl, and hepatic and biliary enzymes were within normal limits. To determine the source of her stomachache and slight fever, immediate imaging studies were performed. CT scans revealed improvement of her pneumonia; however, one gallstone (16 × 9 mm) was revealed in the gallbladder with thickening of the gallbladder wall that was not detected on the previous CTs (fig. 1a, b). Therefore, CTRX-induced gallbladder pseudolithiasis was suspected, and CTRX was immediately discontinued. The total dose of CTRX administered was 7 g over 13 days. Although her stomachache had completely resolved 4 days after CTRX cessation, follow-up CTs demonstrated no significant change in the gallstone or gallbladder wall thickness at day 5 following CTRX cessation. Twelve days following CTRX withdrawal, the gallstone and increased gallbladder wall thickness gradually improved. Finally, the gallstone completely disappeared 48 days following CTRX cessation (fig. 1c). The patient survived disease free for 5 months after disappearance of the gallstone without any symptoms of cholelithiasis or cholecystitis.


Reversible Ceftriaxone-Induced Pseudolithiasis in an Adult Patient with Maintenance Hemodialysis.

Shima A, Suehiro T, Takii M, Soeda H, Hirakawa M - Case Rep Nephrol Dial (2015)

Images from abdominal CT scanning. The white arrows indicate the gallbladder. a The gallbladder was normal in size, shape, and location, and no gallstone was detected just prior to CTRX administration. b A stone in the gallbladder and thickening of the gallbladder wall were detected 13 days following CTRX initiation. c The stone and thickened wall of the gallbladder resolved 48 days following CTRX cessation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4608644&req=5

Figure 1: Images from abdominal CT scanning. The white arrows indicate the gallbladder. a The gallbladder was normal in size, shape, and location, and no gallstone was detected just prior to CTRX administration. b A stone in the gallbladder and thickening of the gallbladder wall were detected 13 days following CTRX initiation. c The stone and thickened wall of the gallbladder resolved 48 days following CTRX cessation.
Mentions: The cough, fever, general fatigue, and laboratory data steadily improved following CTRX administration. The WBC count was 5,300/μl and the CRP level was 1.4 mg/dl on the 11th day after CTRX initiation. However, on the 13th day, she unexpectedly presented with stomachache around the right hypochondrium with a firm, round mass and a slight fever of 37.2°C. The WBC count was 10,560/μl, the CRP level was 8.8 mg/dl, and hepatic and biliary enzymes were within normal limits. To determine the source of her stomachache and slight fever, immediate imaging studies were performed. CT scans revealed improvement of her pneumonia; however, one gallstone (16 × 9 mm) was revealed in the gallbladder with thickening of the gallbladder wall that was not detected on the previous CTs (fig. 1a, b). Therefore, CTRX-induced gallbladder pseudolithiasis was suspected, and CTRX was immediately discontinued. The total dose of CTRX administered was 7 g over 13 days. Although her stomachache had completely resolved 4 days after CTRX cessation, follow-up CTs demonstrated no significant change in the gallstone or gallbladder wall thickness at day 5 following CTRX cessation. Twelve days following CTRX withdrawal, the gallstone and increased gallbladder wall thickness gradually improved. Finally, the gallstone completely disappeared 48 days following CTRX cessation (fig. 1c). The patient survived disease free for 5 months after disappearance of the gallstone without any symptoms of cholelithiasis or cholecystitis.

Bottom Line: Because of the presence of one gallstone and increased gallbladder wall thickness on computed tomography scans, not detected at the onset of pneumonia, the patient was diagnosed with CTRX-induced gallbladder pseudolithiasis.CTRX was discontinued immediately.At 48 days following CTRX withdrawal, the gallstone and thickening of the gallbladder wall had completely resolved.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, Harasanshin Hospital, Fukuoka, Japan.

ABSTRACT
Ceftriaxone (CTRX) is a third-generation cephalosporin widely used for the treatment of bacterial infections in patients with renal disease because of its excretion by both renal and hepatic mechanisms. Biliary pseudolithiasis is a known CTRX-associated complication; however, there have been no studies of this adverse event in adult patients receiving maintenance hemodialysis. Here we report the case of a 79-year-old Japanese woman with end-stage renal disease (ESRD) receiving maintenance hemodialysis who developed CTRX-induced pseudolithiasis. The patient received CTRX for bronchial pneumonia. Fifteen days following CTRX initiation, the patient presented with stomachache. Because of the presence of one gallstone and increased gallbladder wall thickness on computed tomography scans, not detected at the onset of pneumonia, the patient was diagnosed with CTRX-induced gallbladder pseudolithiasis. CTRX was discontinued immediately. At 48 days following CTRX withdrawal, the gallstone and thickening of the gallbladder wall had completely resolved. ESRD may be a risk factor for CTRX-induced pseudolithiasis as hepatic excretion of CTRX is the predominant clearance mechanism in patients with ESRD. More attention should be paid to CTRX-induced pseudolithiasis following the use of CTRX in ESRD patients.

No MeSH data available.


Related in: MedlinePlus