SHM Converge Scientific Abstract ePoster Gallery-Meropenem Induced Cholestasis: A Rare Complication of a Well-Tolerated Drug

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This case report describes a rare instance of <strong>meropenem-induced cholestasis</strong> in a 57-year-old man with insulin-dependent diabetes, polymicrobial foot infection, and sepsis. He was treated with meropenem, daptomycin, and micafungin for osteomyelitis after presenting with fatigue, poor appetite, weight loss, and wet gangrene of the left great toe.

During treatment, his liver tests worsened in a <strong>cholestatic pattern</strong>, with a marked rise in <strong>alkaline phosphatase</strong> compared with only mild increases in AST and ALT. He also developed <strong>pruritus</strong> and a mild bilirubin elevation. His <strong>R value</strong> was 0.15, strongly supporting cholestatic injury. Gamma-glutamyl transferase was also significantly elevated, confirming a hepatobiliary source for the alkaline phosphatase rise.

Common causes of cholestasis were investigated and excluded. Right upper quadrant ultrasound showed no biliary obstruction or ductal dilation, and autoimmune markers such as antimitochondrial and anti-smooth muscle antibodies were negative. After meropenem was stopped and replaced with levofloxacin and Bactrim, his bilirubin normalized quickly, pruritus resolved, and liver enzymes gradually returned toward baseline over two weeks.

The report emphasizes that <strong>meropenem is usually well tolerated</strong>, but it can rarely cause clinically significant liver injury, including cholestasis and even <strong>vanishing bile duct syndrome</strong>. Because drug-induced liver injury can mimic other hepatobiliary diseases, clinicians should consider meropenem as a possible cause when liver enzymes rise during therapy, especially when the pattern is cholestatic and improves after the drug is discontinued.

Asset Subtitle

Shreyesi Srivastava

Meta Tag

Author List Harnet Grewal, Omair Hasan, Randy Odero, Shreyesi Srivastava

Category Clinical Vignettes

Concept Meropenem

Concept Cholestatic Liver Injury

Concept Drug-Induced Liver Injury

Concept Cholestasis

Concept R Value

Distinguished Non-Finalist

Presenter Organization Abrazo Health Internal Medicine Residency Program

Presenting Author Shreyesi Srivastava

Track Adult

Keywords

meropenem-induced cholestasis

cholestatic liver injury

alkaline phosphatase

pruritus

drug-induced liver injury

vanishing bile duct syndrome

gamma-glutamyl transferase

biliary obstruction exclusion

osteomyelitis treatment

sepsis

Meropenem

Cholestatic Liver Injury

Drug-Induced Liver Injury

Cholestasis

R Value