Meropenem-induced cholestasis in a pyelonephritis patient: A case report and evaluation using the updated RUCAM scale

Abstract

Background: Meropenem, a broad-spectrum carbapenem antibiotic, is widely used to treat severe infections but has been associated with rare cases of drug-induced liver injury, including cholestasis. Recognizing and managing this potential adverse effect is essential for ensuring patient safety, particularly in the context of prolonged antibiotic use. Case presentation: We report a case of meropenem-induced cholestasis in a 57-year-old female patient with a history of recurrent urinary tract infections. The patient developed elevated liver enzymes and jaundice after the initiation of meropenem therapy. This report describes the clinical presentation, diagnostic workup, management, and outcome. The case was assessed using the updated Roussel Uclaf Causality Assessment Method scale, yielding a score of 9, indicating a “highly probable” causality. This case highlights the importance of vigilant liver function monitoring in patients receiving meropenem and other potentially hepatotoxic medications. Conclusion: As antibiotic stewardship becomes increasingly crucial in mitigating antimicrobial resistance, recognizing and understanding the potential side effects of these agents is essential for safer prescribing practices. Relevance for patients: This case highlights the importance of vigilant liver function monitoring in patients on meropenem, reinforcing early recognition, and discontinuation to enhance patient safety and support personalized antibiotic therapy.

Keywords

Meropenem / Cholestasis / Drug-induced liver injury / Updated Roussel Uclaf Causality Assessment Method / Roussel Uclaf Causality Assessment Method