An ultrasound done for right upper quadrant discomfort in a 7-year-old on prolonged IV ceftriaxone shows echogenic foci in the gallbladder without wall thickening. The child is afebrile and liver enzymes are normal. The most likely diagnosis is:

• A Ceftriaxone-associated biliary pseudolithiasis ✓
• B Acute calculous cholecystitis secondary to lithogenic bile
• C Emphysematous cholecystitis complicating typhoid carrier state
• D Porcelain gallbladder from chronic inflammation

Explanation

Ceftriaxone is excreted substantially in bile, and as a divalent anion it can form insoluble calcium salts that precipitate as biliary sludge or pseudo stones, particularly in children and patients receiving prolonged or high doses. This pseudolithiasis is reversible and usually resolves after stopping the drug, so supportive management suffices. True cholecystitis requires wall thickening, fever or leukocytosis, none of which are present here, and porcelain gallbladder takes years to develop.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.