Page 83 - JCTR-11-1

Journal of Clinical and

Translational Research

CASE REPORT
Meropenem-induced cholestasis in a

pyelonephritis patient: A case report and
evaluation using the updated RUCAM scale

Shatavisa Mukherjee*

Department of Clinical and Experimental Pharmacology, School of Tropical Medicine, Kolkata, West
Bengal, India

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
*Corresponding author:
Shatavisa Mukherjee cholestasis in a 57-year-old female patient with a history of recurrent urinary tract
(shatavisa100@gmail.com) infections. The patient developed elevated liver enzymes and jaundice after the
Citation: Mukherjee S. initiation of meropenem therapy. This report describes the clinical presentation,
Meropenem-induced cholestasis diagnostic workup, management, and outcome. The case was assessed using
in a pyelonephritis patient: A case the updated Roussel Uclaf Causality Assessment Method scale, yielding a score
report and evaluation using the
updated RUCAM scale. J Clin of 9, indicating a “highly probable” causality. This case highlights the importance
Transl Res. 2025;11(1):77-81. of vigilant liver function monitoring in patients receiving meropenem and other
doi: 10.36922/jctr.24.00072 potentially hepatotoxic medications. Conclusion: As antibiotic stewardship
Received: October 26, 2024 becomes increasingly crucial in mitigating antimicrobial resistance, recognizing
and understanding the potential side effects of these agents is essential for safer
1st revised: December 3, 2024
prescribing practices. Relevance for patients: This case highlights the importance
2nd revised: December 4, 2024 of vigilant liver function monitoring in patients on meropenem, reinforcing early
3rd revised: January 3, 2025 recognition, and discontinuation to enhance patient safety and support personalized
antibiotic therapy.
4th revised: January 4, 2025
Accepted: January 17, 2025
Keywords: Meropenem; Cholestasis; Drug-induced liver injury; Updated Roussel Uclaf
Published online: February 7,
2025 Causality Assessment Method; Roussel Uclaf Causality Assessment Method
Copyright: © 2025 Author(s).
This is an open-access article
distributed under the terms of the
Creative Commons AttributionNon- 1. Introduction
Commercial 4.0 International
(CC BY-NC 4.0), which permits all Meropenem is a broad-spectrum carbapenem antibiotic widely used in clinical practice
non-commercial use, distribution, to treat severe and life-threatening infections caused by a variety of Gram-positive and
and reproduction in any medium, Gram-negative bacteria. Its mechanism of action involves inhibiting bacterial cell wall
provided the original work is
properly cited. synthesis, making it effective against resistant strains, including those producing beta-
lactamases. Given its potent efficacy, meropenem is often reserved for serious infections
Publisher’s Note: AccScience
Publishing remains neutral with such as pneumonia, meningitis, sepsis, and complicated urinary tract infections. 1,2
regard to jurisdictional claims in
published maps and institutional While generally well-tolerated, meropenem is not without potential adverse effects.
affiliations Drug-induced liver injury is a rare but clinically significant complication associated

Volume 11 Issue 1 (2025) 77 doi: 10.36922/jctr.24.00072