Biliary pseudolithiasis is an unusual complication of

ceftriaxone Ceftriaxone, sold under the brand name Rocephin, is a third-generation cephalosporin antibiotic used for the treatment of a number of bacterial infections. These include middle ear infections, endocarditis, meningitis, pneumonia, bone and joint ...

where the drug complexes with calcium and mimics gallstones. It is reversed when ceftriaxone administration is stopped. It was first described in 1988 by Schaad et al. as "reversible ceftriaxone-associated biliary pseudolithiasis". Ceftriaxone has been frequently associated with biliary sludge or biliary pseudolithiasis in subsequent reports. Ceftriaxone is

excreted Excretion is a process in which metabolic waste is eliminated from an organism. In vertebrates this is primarily carried out by the lungs, kidneys, and skin. This is in contrast with secretion, where the substance may have specific tasks after lea ...

primarily through the

urine Urine is a liquid by-product of metabolism in humans and in many other animals. Urine flows from the kidneys through the ureters to the urinary bladder. Urination results in urine being excretion, excreted from the body through the urethra. Cel ...

, but also through the bile, up to 40% of its excretion, with concentrations in the bile 20-150 times higher than in the serum. It forms a

calcium Calcium is a chemical element with the symbol Ca and atomic number 20. As an alkaline earth metal, calcium is a reactive metal that forms a dark oxide-nitride layer when exposed to air. Its physical and chemical properties are most similar to ...

salt Salt is a mineral composed primarily of sodium chloride (NaCl), a chemical compound belonging to the larger class of salts; salt in the form of a natural crystalline mineral is known as rock salt or halite. Salt is present in vast quantitie ...

in the gallbladder, which can exceed its

solubility In chemistry, solubility is the ability of a substance, the solute, to form a solution with another substance, the solvent. Insolubility is the opposite property, the inability of the solute to form such a solution. The extent of the solubil ...

and create precipitates that resemble gallstones on

ultrasonography Ultrasound is sound waves with frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies fr ...

. The incidence of pseudolithiasis in children treated with ceftriaxone is up to 25%, but most patients are asymptomatic. Risk factors for biliary pseudolithiasis include age greater than 24 months,

gram-negative Gram-negative bacteria are bacteria that do not retain the crystal violet stain used in the Gram staining method of bacterial differentiation. They are characterized by their cell envelopes, which are composed of a thin peptidoglycan cell wall ...

sepsis Sepsis, formerly known as septicemia (septicaemia in British English) or blood poisoning, is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage is follo ...

, high doses of ceftriaxone,

hypercalcemia Hypercalcemia, also spelled hypercalcaemia, is a high calcium (Ca2+) level in the blood serum. The normal range is 2.1–2.6 mmol/L (8.8–10.7 mg/dL, 4.3–5.2 mEq/L), with levels greater than 2.6 mmol/L defined as hypercalcemi ...

surgery Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...

, and decreased bile flow/increased ceftriaxone excretion in bile. Conservative management with serial ultrasounds is recommended until the "stones" completely resolve. If associated with ceftriaxone, it resolves on average about 2 weeks after the ceftriaxone is stopped.

Ceftriaxone

Ceftriaxone sold under the brand name Rocephin, is a third-generation

cephalosporin antibiotic The cephalosporins (sg. ) are a class of β-lactam antibiotics originally derived from the fungus ''Acremonium'', which was previously known as ''Cephalosporium''. Together with cephamycins, they constitute a subgroup of β-lactam antibiotics ...

used for the treatment of a number of bacterial infections. These include

middle ear infections Otitis media is a group of Inflammation, inflammatory diseases of the middle ear. One of the two main types is acute otitis media (AOM), an infection of rapid onset that usually presents with ear pain. In young children this may result in pulling ...

endocarditis Endocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves. Other structures that may be involved include the interventricular septum, the chordae tendineae, the mural endocardium, or the ...

meningitis Meningitis is acute or chronic inflammation of the protective membranes covering the brain and spinal cord, collectively called the meninges. The most common symptoms are fever, headache, and neck stiffness. Other symptoms include confusion or ...

pneumonia Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severity ...

, bone and joint infections, intra-abdominal infections, skin infections, urinary tract infections, gonorrhea, and

pelvic inflammatory disease Pelvic inflammatory disease, also known as pelvic inflammatory disorder (PID), is an infection of the upper part of the female reproductive system, namely the uterus, fallopian tubes, and ovaries, and inside of the pelvis. Often, there may be no ...

. It is also sometimes used before surgery and following a

bite wound Biting is a common zoological behavior involving the active, rapid closing of the jaw around an object. This behavior is found in toothed animals such as mammals, reptiles, amphibians and fish, but can also exist in arthropods. Myocytic contrac ...

to try to prevent infection. Ceftriaxone can be given by

injection into a vein Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutrie ...

or into a muscle.

References

{{reflist Medical terminology Disorders of gallbladder, biliary tract and pancreas

Ceftriaxone

See also

References