Vol.67 No.5 September 2019
Successful treatment with endoscopic sphincterotomy and stone extraction of ceftriaxone-associated pseudolithiasis in an elderly patient with bronchopneumonia: a case report
1)Department of Respiratory Medicine, Kanazawa Medical Center, 1-1 Shimoishibiki-machi, Kanazawa, Ishikawa, Japan
2)Department of Gastroenterology, Kanazawa Medical Center
3)Department of Respiratory Medicine, Kanazawa University Hospital
Abstract
An 84-year-old woman was admitted to our hospital with fever and a productive cough. Chest X-ray and computed tomography revealed a patchy shadow in the upper lobe of the right lung. Laboratory findings showed an elevated white blood cell count and increased C-reactive protein concentration. The patient was diagnosed as having bronchopneumonia in the right lung. She was given ceftriaxone (CTRX) intravenously at a dose of 2 g/day from the first day of admission. On day 7, her symptoms dramatically improved, and the patchy shadow in the right lung disappeared; therefore, the intravenous administration of CTRX was discontinued. However, on day 9, she complained of a sudden right hypochondrial pain, accompanied by elevated biliary and hepatic enzyme levels. An abdominal CT scan revealed sludge in the gallbladder and stones in the common bile duct; these findings were not present at the time of admission. Based on these findings, symptoms, and clinical course, the patient was diagnosed as having CTRX-associated pseudolithiasis. On day 11 of hospitalization, she underwent endoscopic retrograde cholangiopancreatography owing to persistent hypochondrial pain. Following an endoscopic sphincterotomy and stone extraction, no symptoms suggestive of the recurrence of pseudolithiasis were observed. CTRX-associated pseudolithiasis cases are frequently successfully treated by discontinuing CTRX alone. However, our case demonstrates the importance of considering the necessity of therapeutic endoscopy when the symptoms of pseudolithiasis persist despite discontinuing CTRX treatment.
Key word
ceftriaxone, pseudolithiasis, sphincterotomy, stone extraction
Received
March 4, 2019
Accepted
April 10, 2019
Jpn. J. Chemother. 67 (5): 591-596, 2019
