Cefotaxime-induced inspissated bile syndrome in a newborn: A case report

Abstract

Introduction: Inspissated bile syndrome (IBS) is a rare cause of neonatal jaundice. Although it is mostly described in children with RH incompatibilities, some medications such as cefotaxime and ceftriaxone have also been implicated. Case presentation: We present a case of a 14-day-old male who developed pale stools after three days of being treated with intravenous cefotaxime for sepsis and neonatal jaundice. The liver function test (LFT) showed conjugated hyperbilirubinemia (Total bilirubin = 268umol/L; conjugated bilirubin = 124μmol/L). On the third day of treatment, the child developed pale stools. An ultrasound scan showed biliary sludge with a differential of biliary atresia. A laparotomy was performed with findings consistent with IBS (viscous sludge). A single-stage irrigation of the biliary tree using saline was performed. The patient was discharged on post-operative day seven after the jaundice cleared with an unremarkable post-operative period. The patient was lost to follow-up care. He presented later at 11 months of life with a normal liver function test but had developed mixed cerebral palsy. Conclusion: The use of cefotaxime in the setting of sepsis can precipitate IBS. Laparotomy with single-stage irrigation of the biliary tree is a viable option for resolution of the syndrome in low-resource settings.

Keywords

• Inspissated bile syndrome
• Cefotaxime
• Jaundice
• Case report