Abstract: Objective To analyze the clinical data and imaging manifestations of patients with meropenem-induced drug-induced liver injury (DILI), and to provide a basis for clinical recognition, diagnosis, and treatment. Methods Sixty-two patients with DILI diagnosed during meropenem treatment in Anhui Zhongke Gengjiu Hospital between January 2022 and June 2025 were retrospectively included, which were divided into three types: hepatocellular injury type (n=32), cholestatic type (n=19) and mixed type (n=11). The liver function indexes and imaging manifestations of each type were analyzed and compared. Results The ALT and AST levels in the cholestatic type were (55.2±17.2) U/L and (61.4±20.1) U/L, respectively, which were significantly lower than those in the other two types [(145.3±27.8) U/L and (162.7±36.1) U/L; (137.6±38.0) U/L and (144.1±41.3) U/L; P<0.05]. Meanwhile, the ALP and TBil levels in the hepatocellular injury type were (96.5±25.1) U/L and (25.1±7.3) μmol/L, respectively, which were significantly lower than those in the other two types [(246.2±52.6) U/L and (56.2±14.7) μmol/L; (228.1±47.1) U/L and (49.5±16.1) μmol/L; P<0.05]. All patients underwent liver ultrasound or MRI examination. Imaging results showed that 17 patients (27.4%) had mildly irregular liver margins or heterogeneous parenchymal echotexture, suggesting possible hepatic parenchymal inflammation; 19 patients (30.6%) had mild intrahepatic bile duct dilation, indicating impaired bile excretion; 22 patients (35.5%) presented with mild to moderate splenomegaly, which might be associated with elevated portal pressure or systemic inflammatory responses; and 10 patients (16.1%) exhibited mild thickening of the gallbladder wall. There were no statistically significant differences in imaging features among different DILI types (P>0.05), although bile duct dilation and gallbladder wall thickening were more frequently observed in patients with cholestatic or mixed injury types. Conclusion Meropenem-induced DILI presents with diverse clinical manifestations, ranging from acute hepatitis characterized by hepatocellular injury to marked cholestatic or mixed-type liver injury. While no significant differences in imaging features were observed among different DILI types, bile duct dilation and gallbladder wall thickening were more commonly seen in the cholestatic and mixed types.

Key words: Drug-induced liver injury, Meropenem, Imaging manifestations