Stool and urine cultures were negative. The following day she complained of abdominal pain and on examination, mild abdominal distention with an enlarged tender liver of 9 cm below the costal margin was found. Ceftriaxone was discontinued after the second dose and was replaced by injectable Augmentin. Following this, the patient's condition improved dramatically, abdominal pain reduced and after two days, the liver was palpable 3 cm below the costal margin. She was discharged 2 September 1993 with oral Augmentin and on follow-up after 10 days, she was normal and no hepatomegaly was noted.
Ceftriaxone is a third generation cephalosporin with a wide spectrum of antibacterial activity.
It is being extensively used in meningitis, sepsis, enteric fever and other infectious illnesses and biliary infections because of its long plasma half life2 and ease of administration in ambulatory setup. There are numerous reports suggesting the occurrence of gallbladder sludge in patients receiving ceftriaxone, especially in a large dose.1,3-5 They are mostly rapidly reversible once the drug is discontinued. But acute hepatomegaly following ceftriaxone therapy is not reported as far as we know. Both of our patients were receiving high doses of ceftriaxone and there was no prior clinical liver enlargement in them. The hepatomegaly was moderate, tender, and associated with raised transaminases but normal total serum bilirubin and alkaline phosphatase.