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Clenbuterol poisoning due to a mix‐up between clenbuterol hydrochloride and other similarly shaped drug tablets

LSFX should be used with caution in older patients. Biliary pseudolithiasis has been mainly reported in pediatric patients treated with ceftriaxone, with a frequency of 25% according to a systematic review. To the best of our knowledge, this is the first report of pseudolithiasis caused by LSFX. As clinical symptoms alone might not always suggest pseudolithiasis, the exact frequency in the older adult population is unknown. Imaging studies are necessary for the diagnosis. In the present case, pseudolithiasis was diagnosed by serial CT scans, but abdominal ultrasonography is useful in screening for it. However, LSFX administration does not necessarily induce pseudolithiasis formation. Risk factors of antibiotic pseudolithiasis generally include use of high doses, administration by rapid infusion, dehydration, renal failure, hypoalbuminemia, infusion of fluids containing calcium and administration during fasting. Although various factors can contribute to the onset of pseudolithiasis, the fact that the present patient was older, and had experienced bed rest and fasting during treatment for aspiration pneumonia, which contributed to the slowing of his gallbladder contractions, suggested that the patient was at a high risk of pseudolithiasis morbidity. In conclusion, it should be noted that biliary pseudolithiasis is observed immediately after a loading dose of LSFX in an older patient. Imaging studies, such as an abdominal ultrasonography, should be carried out during and after LSFX administration, and LSFX should be discontinued immediately in cases where pseudolithiasis is suspected. In addition, it might be necessary to consider not carrying out a loading dose of LSFX in older adults depending on their general condition.