Mukul Sharda, BS; Arjan Bindra, BS; Vineesha Kollipara, DO, MPH; Pinky Jha, MD, MPH
WMJ. 2026;125(2):312-315. Published June 2, 2026.
ABSTRACT
Introduction: Ceftriaxone is a commonly used third-generation cephalosporin; however, rare cases of drug-induced liver injury have been reported. Atypical hepatic responses in adults at standard doses warrant clinical attention.
Case Presentation: A 48-year-old woman with a history of nephrolithiasis, cholecystectomy, and Roux-en-Y gastric bypass presented with abdominal pain. After receiving a 1-g dose of ceftriaxone, she developed significant liver enzyme elevation aspartate aminotransferase 725 U/L, alanine aminotransferase 455 U/L, and alkaline phosphatase 319 U/L). Evaluation for viral and autoimmune causes was negative. A chart review revealed prior similar episodes linked to ceftriaxone use.
Discussion: Ceftriaxone-induced hepatitis is more frequently reported in pediatric populations and typically associated with higher doses. Adult cases with such marked liver function test elevations are rarely documented.
Conclusions: This case highlights an unusual adult presentation of ceftriaxone-induced hepatitis. Clinicians should consider ceftriaxone as a potential cause of liver injury, even at standard doses, particularly in patients with a history of adverse reactions.