Cytomegalovirus infection and biliary atresia in a newborn infant

Abstract number: 1135_236

Mandraveli-Hatzikosta K., Pape-Chrisafi M., Fotoulaki M., Papadopoulou D., Alexiou-Daniel S.

A 2-month-old female infant was admitted to the paediatric clinic because of progressive and unexplained jaundice and light coloured stools. Symptoms began 20 days before admission. On examination, pediatricians found distened abdomen, hepatomegaly and enlargement of the spleen. The ultrasound test detected a tiny gall bladder, while during the HIDA scan test the radioactive dye could not flew through the billiary system. Blood tests showed the following: PT and PTT times were prolonged, repeatedly blood cultures were negative and serologic tests ruled out an acute infection with A, B, C and E hepatitis viruses, HIV, HSV, VZV, EBV, Rubella viruses, Toxoplasma gondi and Coxiella burnetii. CMV serologic study was based on the perfomance of ELISA ( DiaSorin s.r.l.) and IFA ( PANBIO, inc ) methods. Sera samples were collected on the 1st, 5th, 8th day after admission. CMV IgG antibodies were found positive by ELISA test (54 Au/ml, 60 Au/ml, 66 Au/ml, respectively ). In all the tested samples CMV IgM antibodies were found positive by both ELISA (+) and IFA tests ( 1:40, 1:80, 1:80 respectively ). At the same times, PCR analysis was carried out (COBAS AMPLICOR CMV MONITOR test) and detected CMV-DNA in blood and urine samples. Only the first blood sample was positive (5.2 × 10² copies/ml), while two urine samples were CMV positive (3.45 × 10³, 2.69 × 10⁴ copies/ml). The baby's mother was CMV-IgG (+) 236 Au/ml and CMV-IgM (-). CMV-DNA has not been detected in her blood and urine samples. Under antiviral treatment with ganciclovir first the blood on the 5th day, and then urine samples on the 8th day became negative. However, this did not affect the progressive damage of the liver. Portal hypertension and hepatic coma eventually occurred.

Conclusion:  

CMV perinatal or congenital infection may participated in the etiopathogenesis of the the neonatal cholestasis. The cause is difficult to be determined, since there was no history of maternal CMV infection and the serology of the mother was unknown before and during pregnancy and at the time of the birth. At that time, the serology of the infant was also unknown and CMV-DNA was detected 2 months later.