Cytomegalovirus-associated biliary atresia: Case report
DOI:
https://doi.org/10.22516/25007440.576Keywords:
Biliary Atresia, Cytomegalovirus, Obstructive jaundiceAbstract
Biliary atresia associated with positive cytomegalovirus IgM results is a rare condition characterized by progressive inflammatory obliteration of the intra- or extrahepatic ducts. It is caused by a perinatal autoimmune reaction against cytomegalovirus (CMV). Diagnosis is made based on positive IgM for CMV and liver biopsy with evidence of bile duct atresia. Knowledge and timely identification of this disease leads to early surgical management, considerably improving the prognosis of these patients. This is the clinical case of an 82-day-old female patient with late-onset acholia, choluria, and jaundice, associated with conjugated hyperbilirubinemia, elevated liver function tests and positive CMV IgM results. Intraoperative cholangioresonance confirmed bile duct atresia. The Kasai procedure was performed, and a liver biopsy was taken, confirming the diagnosis.
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References
Averbukh LD, Wu GY. Evidence for Viral Induction of Biliary Atresia: A Review. Journal of clinical and translational hepatology. 2018;6(4):410-9. https://doi.org/10.14218/JCTH.2018.00046
Moore SW, Zabiegaj-Zwick C, Nel E. Problems related to CMV infection and biliary atresia. S Afr Med J. 2012;102(11 Pt 2):890-2. https://doi.org/10.7196/SAMJ.6163
Xu Y, Yu J, Zhang R, Yin Y, Ye J, Tan L, Xia H. The perinatal infection of cytomeg-alovirus is an important etiology for biliary atresia in China. Clin Pediatr (Phila). 2012;51(2):109-13. 4. https://doi.org/10.1177/0009922811406264
Bezerra JA, Wells RG, Mack CL, Karpen SJ, Hoofnagle JH, Doo E, Sokol RJ. Biliary Atresia: Clinical and Research Challenges for the Twenty-First Century. Hepatology. 2018;68(3):1163-73. https://doi.org/10.1002/hep.29905
Lakshminarayanan B, Davenport M. Biliary atresia: A comprehensive review. J Autoimmun. 2016;73:1-9. https://doi.org/10.1016/j.jaut.2016.06.005
Hartley JL, Davenport M, Kelly DA. Biliary atresia. Lancet. 2009;374(9702):1704-13. https://doi.org/10.1016/S0140-6736(09)60946-6
Plosa EJ, Esbenshade JC, Fuller MP, Weitkamp JH. Cytomegalovirus infection. Pediatr Rev. 2012;33(4):156-63; quiz 63. https://doi.org/10.1542/pir.33-4-156
Li W-W, Shan J-J, Lin L-L, Xie T, He L-L, Yang Y, Wang SC. Disturbance in Plasma Metabolic Profile in Different Types of Human Cytomegalovirus-Induced Liver Injury in In-fants. Scientific Reports. 2017;7(1):15696. https://doi.org/10.1038/s41598-017-16051-8
Wang W, Zheng S, Shong Z, Zhao R. Development of a guinea pig model of peri-natal cytomegalovirus-induced hepatobiliary injury. Fetal Pediatr Pathol. 2011;30(5):301-11. https://doi.org/10.3109/15513815.2011.572959
Zani A, Quaglia A, Hadzić N, Zuckerman M, Davenport M. Cytomegalovirus-associated biliary atresia: An aetiological and prognostic subgroup. J Pediatr Surg. 2015;50(10):1739-45. https://doi.org/10.1016/j.jpedsurg.2015.03.001
Mack CL. The pathogenesis of biliary atresia: evidence for a virus-induced autoim-mune disease. Semin Liver Dis. 2007;27(3):233-42. https://doi.org/10.1055/s-2007-985068
Fawaz R, Baumann U, Ekong U, Fischler B, Hadzic N, Mack CL, McLin VA, Molleston JP, Neimark E, Ng VL, Karpen SJ. Guideline for the Evaluation of Cholestatic Jaundice in Infants: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2017;64(1):154-68. https://doi.org/10.1097/MPG.0000000000001334
He JP, Hao Y, Wang XL, Yang XJ, Shao JF, Feng JX. Comparison of different non-invasive diagnostic methods for biliary atresia: a meta-analysis. World J Pediatr. 2016;12(1):35-43. https://doi.org/10.1007/s12519-015-0071-x
Dong C, Zhu HY, Chen YC, Luo XP, Huang ZH. Clinical Assessment of Differential Diagnostic Methods in Infants with Cholestasis due to Biliary Atresia or Non-Biliary Atresia. Curr Med Sci. 2018;38(1):137-43. https://doi.org/10.1007/s11596-018-1857-6
Serinet MO, Wildhaber BE, Broué P, Lachaux A, Sarles J, Jacquemin E, Gauthier F, Chardot C. Impact of age at Kasai operation on its results in late childhood and adolescence: a rational basis for biliary atresia screening. Pediatrics. 2009;123(5):1280-6. https://doi.org/10.1542/peds.2008-1949
Fischler B, Svensson JF, Nemeth A. Early cytomegalovirus infection and the long-term outcome of biliary atresia. Acta Paediatr. 2009;98(10):1600-2. https://doi.org/10.1111/j.1651-2227.2009.01416.x
Parolini F, Hadzic N, Davenport M. Adjuvant therapy of cytomegalovirus IgM + ve associated biliary atresia: Prima facie evidence of effect. Journal of Pediatric Surgery. 2019;54(9):1941-5. https://doi.org/10.1016/j.jpedsurg.2018.12.014

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