Gall bladder sludge and biliary pseudolithiasis as rare complications of ceftriaxone therapy in adult patients - A case report including sonographic workup.

Background: Ceftriaxone-induced biliary pseudolithiasis is a disease entity frequently observed in children, while it is rarely seen in adult patients. We provide a thorough sonographic workup of the case to guide sonographers confronted with it.

Case report: A 41-years-old male patient with sonographically confirmed, culture-negative endocarditis accompanied by repeated fever episodes received 4g ceftriaxone per day next to ampicillin and gentamicin as an element of his antibiotic therapy. At day 4 of treatment, signs of gall bladder sludge and biliary pseudolithiasis were first seen in sonography. At day 17, abdominal pain over 30 min and increased liver and pancreatic enzymes pointed towards temporal duct obstruction as a complication and ceftriaxone therapy had to be preterm cancelled. A sonographic work-up of the stepwise improvement of the sonographic findings after the end of the ceftriaxone therapy is provided, a reemergence of endocarditis was not observed.

Discussion: The case reminds of a rarely recognized, usually reversible side effect of high-dose ceftriaxone therapy and its complications. The sonographic work-up may serve as guidance for clinicians during follow-up assessments.

Conclusions: Although ceftriaxone allows usually well-tolerated antimicrobial therapies, biliary pseudolithiasis should be kept in mind as a rare but sometimes non-ignorable side effect.