Ceftriaxone-associated Pseudolithiasis in the Gallbladder and Bile Duct of an Elderly Patient.

A 78-year-old man had been undergoing treatment with Cefamezin for pyogenic spondylitis. Because of complication of a urinary tract infection, the medication was switched to ceftriaxone (CTRX) 2 g/day. On day 18 after starting CTRX, the patient began experiencing abdominal pain. Computed tomography (CT) and endoscopic ultrasound led to the identification of calculi in the gallbladder and extrahepatic bile duct with a peculiar formation. We suspected CTRX-associated pseudo-cholecystolithiasis and pseudo-choledocholithiasis, although CT performed at admission had shown no such findings. Therefore, CTRX was discontinued. By day 17 after CTRX cessation, both the pseudo-cholecystolithiasis and pseudo-choledocholithiasis had disappeared.

[CEFTRIAXONE-INDUCED GALLBADDER LITHIASIS IN CASE OF INTENSTINAL BACTERIAL INFECTIONS (CASE REPORTS)].

Ceftriaxone is a third generation cephalosporin antibiotic and is one of the most often applicable parenteral drug, which has wide antimicrobial activity range. According to the literature gall bladder lithiasis is a complication which is described in the first days of the treatment with this antibiotic. The cases are seen mostly as undergdiagnosed conditions when ultrasound examination is performed due to the abdominal colics. The aim of the study was to observe Cholelithiasis in ceftriaxone-treated patients. Last year few cases of Cholelithiasis were observed in Children's Infectious Diseases Hospital. All of them were related to the dysentery treatment with ceftriaxone. All of the cases of Cholelithiasis were diagnosed at the beginning of the antibiotic therapy (in first 2-3 days of hospitalization). Gall bladder concernments/sludge were found accidentally. Cholelithiasis in these cases was transitory and in 2 weeks ultrasound investigation revealed no calculi/sludge in the gall bladder. Further findings are supposed to be analyzed on a bigger number of the patients. It is necessary to follow up with gall bladder concernments till their absolute resolution.

Hormonal contraception after intrahepatic cholestasis of pregnancy.

OBJECTIVE: Comparing the use of oral contraception (OC), treatment side effects and the incidence of cholecystolithiasis in women with a history of intrahepatic cholestasis of pregnancy (ICP), before and after introducing ursodeoxycholic acid (UDCA) in the treatment. DESIGN: Regional epidemiological. SETTING: Department of Obstetrics and Gynecology, General Hospital, Trencin, Slovak Republic. METHODS: Retrospective analysis of 79 deliveries with ICP between 1992 and 2004. Group 1 included 36 women who delivered between 1992 and 1996 and were not treated by UDCA. Group 2 included 43 women who delivered between 1997 and 2004 and were managed with a 500-750 mg daily dose of UDCA administered orally. In 2008, the questionnaire was sent to all treated women with ICP. The analysis was focused on OC use and presence of cholecystolithiasis, or cholecystectomy in individual groups. The incidence of difficulties comparable to ICP was analyzed in OC users. RESULTS: The frequency of ICP was the same in both groups (0.4% of deliveries). The questionnaire response rate was 71%. Analysis was conducted in 56 women with ICP--in Groups 1 and 2 it was 26 and 30 women, respectively (the difference statistically insignificant, p=0.81). In the observed population, 15 women (26.8%) used hormonal contraception--in Groups 1 and 2 it was 42.3% and 13.3%, respectively (statistically significant difference, p=0.015). Only one woman in Group 1 reported pruritus during the use of OCs. The frequency of cholecystolithiasis or cholecystectomy occurrence was 26.8% in the entire population--in Groups 1 and 2 it was 38.5% and 16.7%, respectively (statistically significant difference, p=0.043). CONCLUSION: Based on our results it is possible to consider the use of OC in women with a history of ICP as safe. Only a minimum of side effects have been recorded in relatively high percentage of OC users.

[Reversible ceftriaxone-associated biliary pseudolithiasis in three children with renal diseases].

OBJECTIVE: To study the clinical characteristics of ceftriaxone-associated biliary pseudolithiasis in children with renal diseases. METHOD: Three children with renal diseases developed biliary pseudolithiasis when they were treated with ceftriaxone. Their clinical and laboratory data were retrospectively analyzed. RESULTS: Case one was an 11-year-old boy. The initial diagnosis was primary nephrotic syndrome. Ceftriaxone was administered intravenously at a dose of 2 g/d [50 mg/(kg * d)] for gastroenteritis. After that the boy complained of nausea and loss of appetite. Abdominal sonogram obtained on day 3 of ceftriaxone therapy revealed gallbladder sludge. After cessation of ceftriaxone treatment, symptoms and ultrasound abnormalities gradually disappeared, with complete sonographic resolution after 16 days. Case two was a 10-year-old boy. The primary diagnosis was post-streptococcal glomerulonephritis with acute renal failure. The child was treated with 1.5 g/d [30 mg/(kg * d)] intravenous ceftriaxone for gastroenteritis. After that, the boy complained of nausea and abdominal pain with positive Murphy's sign. Gallstone was detected by ultrasonographic examination on day 6 of ceftriaxone therapy. After cessation of ceftriaxone treatment, symptoms and sonographic abnormalities gradually disappeared, with complete sonographic resolution after 18 days. Case three was a 12-year-old boy. The primary diagnosis was nephrotic syndrome. He was treated with 2 g/d [40 mg/(kg.d)] ceftriaxone for gastroenteritis. Gallbladder lithiasis was detected 17 days after the initiation of ceftriaxone therapy (3 days after cessation of ceftriaxone treatment). Gallbladder sonogram was found to be normal two months after the discontinuation of the therapy. CONCLUSIONS: Biliary pseudolithiasis occurred in 3 cases with renal diseases receiving low doses of ceftriaxone. The risk of developing ceftriaxone-associated biliary pseudolithiasis might increase in patients with renal diseases who are treated with ceftriaxone.

Biliary diseases in heart transplanted patients: a comparison between cyclosporine A versus tacrolimus-based immunosuppression.

A cyclosporine (CsA)-based immunosuppression is associated with an increased incidence of cholelithiasis after heart transplantation. It is not known if tacrolimus (Tac) has comparable biliary side effects in humans. We evaluated the incidence of gallbladder sludge and cholelithiasis under Tac-based immunosuppression by ultrasound examinations in 31 cardiac transplants (25 male, 6 female, mean age: 59 ' 11 years). Data were compared to 57 patients (47 male, 10 female, mean age: 58 ' 11 years) who received CsA-based immunosuppression. 6 patients receiving Tac and 6 patients receiving CsA had already gallstones prior to transplantation so that finally 25 patients of the Tac group and 51 patients of the CsA group could be evaluated. In the Tac group the incidence of biliary sludge was 4% (1 of 25), of gallstones 28% (7 of 25). In comparison, patients receiving CsA developed biliary sludge in also 4% (2 of 51) and gallstones in 25% (13 of 51). Nine of 42 males in the CsA group (21%) and eight of 20 males in the Tac group (40%) developed either gallstones or sludge (n.s). Six of nine females in the CsA group (67%), but none of five females in the Tac group (0%) developed either gallstones or sludge (p = 0.01). In summary, the incidence of biliary disease in patients with Tac is comparable with CsA-based immunosuppression. We recommend regular sonographical examinations to detect biliary diseases as early as possible. In cases of clinically, laboratory and sonographical signs of cholecystitis cholecystectomy is indicated. It seems that towards lithogenicity female patients benefit more from a Tac-based treatment because the occurrence of gallstones is rare.

Ultrasonographic findings in ceftriaxone: associated biliary sludge and pseudolithiasis in children.

PURPOSE: To prospectively evaluate the incidence of biliary sludge and pseudolithiasis in children treated with ceftriaxone. MATERIAL AND METHODS: Thirty-three children (14 girls, 19 boys) treated with ceftriaxone for prophylaxis (n=13) or for an infection (n=20) were included in this study. The incidences of biliary sludge and pseudolithiasis were investigated using ultrasonography. The ultrasonographic evaluations were performed prior to and on the 4th-5th days and on the 8th-10th days of treatment. The patients who had biliary sludge or pseudolithiasis were followed up with ultrasonographic evaluation periodically until these pathological phenomena disappeared. RESULTS: Ceftriaxone was administrated intravenously at a dosage of 100 mg kg(-1) day(-1). Serial gallbladder sonograms were performed before treatment and on the 4th-5th and 8th-10th days of therapy. Nineteen children developed pseudolithiasis and sludge in the gallbladder, and all were asymptomatic. No significant differences were found between the patients with normal versus abnormal sonographic findings in regard to gender, age, duration of the therapy, oral restriction except the presence of surgery (P< 0.005). CONCLUSION: The combination of oral restriction and surgical procedures may be a causal factor in ceftriaxone-associated biliary pseudolithiasis. It is emphasized that when gallstone and/or sludge are detected in the gallbladder in children by ultrasonographic examination, the administration of ceftriaxone must be sought beyond other causative factors.