Meropenem-Induced Possible Mixed Drug-Induced Liver Injury With Cholestatic Evolution: A Case Report Evaluated Using the Updated RUCAM (2016).

Drug-induced liver injury (DILI) remains a diagnosis of exclusion and requires systematic causality assessment. Meropenem is generally considered hepatically safe; however, rare cases of idiosyncratic DILI have been reported. We describe a 33-year-old female who developed progressive elevation of liver tests following exposure to meropenem. Based on R-value calculation, the liver injury pattern was mixed at presentation and peak, with transient hepatocellular features followed by evolution toward a cholestatic pattern during recovery. Extensive imaging, endoscopic evaluation, and serologic testing excluded biliary obstruction, viral hepatitis, and autoimmune disease. Causality assessment using the updated Roussel Uclaf Causality Assessment Method (RUCAM, 2016) yielded a score of 4, indicating possible DILI. This case expands the demographic spectrum of reported meropenem-associated DILI and underscores the importance of early R-value calculation, formal RUCAM-based causality assessment, and prompt withdrawal of the suspected agent.