Central Annals of Pediatrics & Child Health Cite this article: Najmuddin F, Rai R, George R, Lahiri K (2015) Cytomegalovirus Induced Neonatal Cholestasis: A success Story. Ann Pediatr Child Health 3(2): 1056. *Corresponding author Fehmida Najmuddin, D. Y.Patil University, School of medicine, Nerul, Navi Mumbai, 400706, India, Tel: 91- 9920030533; E- mail address: Submitted: 15 January 2015 Accepted: 12 March 2015 Published: 14 March 2015 Copyright © 2015 Najmuddin et al. OPEN ACCESS Keywords • Neonatal cholestasis • Cytomegalovirus • Ganciclovir Case Report Cytomegalovirus Induced Neonatal Cholestasis: A success Story Fehmida Najmuddin*, Rajesh Rai, Riya George, and Keya Lahiri Department of Pediatrics, D.Y.Patil University, School of medicine, India Abstract Neonatal cholestasis is a prolonged elevation of the serum levels of conjugated bilirubin beyond the frst 14 days of life. Commonest etiologies include extrahepatic conditions like biliary atresia, intrahepatic like congenital malformations, infections and inborn errors of metabolism. TORCH infections constitute 22% cases of neonatal hepatitis, of which Cytomegalovirus is the commonest agent. Ganciclovir and its prodrug valganciclovir are recommended in the management of Cytomegalovirus infection. We, hereby report a 2 month old child, a case of Cytomegalovirus induced neonatal cholestasis with marked improvement in clinical and biochemical parameters, post treatment with intravenous ganciclovir. INTRODUCTION Cholestatic jaundice affects approximately 1 in every 2,500 infants [1,2]. It is estimated that approximately 40% of cholestasis in infants is due to neonatal hepatitis [3]. Human cytomegalovirus (CMV) is 1 of 8 human herpes viruses [4], which is the commonest etiological agent responsible for causing neonatal hepatitis [5]. Ganciclovir was the first antiviral agent approved for the treatment of CMV infection. In the past few years, there have been various trials based on the outcome of ganciclovir therapy in CMV induced neonatal hepatitis with satisfactory results [3,4,6]. This case report highlights the outcome of ganciclovir treated CMV neonatal hepatitis. CASE REPORT A two month old female child born of non-consanguineous marriage presented with yellowish discoloration of eyes and skin since day two of birth. There was history of passing clay colored stools since past 1 month. The child was born full term with birth weight of 3 kgs. Antenatal history revealed that the mother was a case of hypothyroidism, on anti-thyroid medication since past two years and HIV status was non- reactive. The child was developmentally normal and belonged to a lower middle class family. On general examination, her weight was 4.4 kgs; length was 54cms, with pallor and icterus. On her abdomen examination there was hepatosplenomegaly (Figure 1) with the rest of the systems being normal. Investigations showed Hemoglobin of 11.6gm/dl, white cell count of 24,800/cumm (35% polymorphs, 60% lymphocytes) with platelet of 461,000/cumm. Liver function showed evidence of direct hyperbilirubinemia with total bilirubin of 23.6 mg/dl, direct bilirubin of 16.2 mg/dl, alanine transaminase=353IU/L, aspartate transaminase= 850 IU/L and alkaline phosphatase =1156 IU/L. Prothrombin time, partial thromboplastin time, serum electrolytes, blood gases and serum ammonia were within normal limits. Thyroid profile and Glucose-6-phosphate dehydrogenase tests were normal. Ultrasonography of the abdomen reported hepatosplenomegaly with normal gall bladder. Hepatobiliary Scintigram after five days of priming with phenobarbitone showed hepatosplenomegaly with moderate impairment of parenchymal function of the liver without any evidence of biliary atresia. TORCH screening showed positive CMV-IgM titer of 6.8 UA/ml (reactive >2.0 UA/ml).An ophthalmic and hearing evaluation was done which was normal. Liver biopsy could not be performed due to negative consent given by the parents for the procedure. The child was then started Figure 1 Showing abdominal distention due to hepatosplenomegaly.