Congenital CMV induced neonatal cholestasis: A case report

Abstract

Cholestatic jaundice in the neonatal period becomes difficult to diagnose because of complex and diverse etiology. The Index case was severe IUGR (intrauterine growth restriction), with a maternal history of infection and leaking per vaginum. The baby cried immediately at birth but was very low birth weight and short for gestation. Soon after birth, the baby developed respiratory distress and had poor activity. The baby was diagnosed of having hyaline membrane disease and early onset of neonatal sepsis and was managed appropriately. Later the baby developed conjugate neonatal hyperbilirubinemia and sepsis was taken as a cause of it and obstructive causes were ruled out. But the baby was not responding well to the treatment and the liver function test remained deranged, so is presented as a diagnostic challenge. The ultrasonography of the abdomen was normal. TORCH (Toxoplasma gondii, Other agents, Rubella, Cytomegalovirus) profile of the baby was sent which turned out to be positive for Cytomegalovirus (CMV). The viral load was high. Hence the baby was treated with Ganciclovir and the baby responded remarkably with the liver enzymes getting reverted to normal and viral load subsequently reduced to zilch. The infant started thriving well and no apparent associated neurological manifestations of the disease were seen in the baby. Currently, the baby is on regular follow-up. The difficulties experienced in the identification of CMV leading to delay in the management of the newborn as well as the positive outcome with Ganciclovir therapy are highlighted in this article. Our goal of reporting this case is to raise pediatricians’ and other stakeholders’ awareness of congenital CMV infection to ensure early detection and appropriate treatment of affected babies, with the ultimate goal of improving their prognosis and preventing the associated audiological and cognitive sequelae. Keywords: Cholestasis; Cytomegalovirus; Gancyclovir.