Introduction Ceftriaxone is a frequent choice in Romanian hospitals for empiric antimicrobial therapy because of its broad spectrum, long half-life, safety and tolerability. However, some relatively rare side effects as renal lithiasis and biliary pseudolithiasis may occur.
Case report A 5 month male toddler was admitted into our unit with extreme agitation and mild respiratory symptoms. The child had interstitial pneumonia and received ceftriaxone intravenously for 7 days in a county hospital. Clinical examination showed productive cough, fine crackles, mild systolic murmur and small crystals in the in diaper. Ultrasound examination of the kidneys revealed the presence of sediment in the bladder and a hyperechoic image of 4 mm in the gallbladder. Complete blood count, urea, creatinine, creatinine clearance, serum glucose, calcium (total and ionised), serum phosphorus, bilirubinemia, alkaline phosphatase were within normal limits. Urinalysis showed calcium carbonate deposit and increased calcium/creatinine ratio. Chest X-Ray revealed discrete bilateral interstitial infiltrate. The echocardiography found permeable foramen ovale and moderate left ventricular diastolic dysfunction. Treatment consist in suspending ceftriaxone administration, antispasmodics, hydrochlorothiazide 6,25 mg/daily and adequate hydration. The child was dismissed after 3 days in good general condition, disappearance of bladder sediment but persistant gallbladder image that disappeared within 3 weeks.
Conclusions This is a particular case of a very young patient with renal and vesicular pseudolithiasis induced by ceftriaxone; the negative family history of kidney stones, a normal intake of vitamin D3 and normal liver and renal function excluded any other cause of lithiasis except the antibiotic itself.