ABSTRACT
INTRODUCTION AND OBJECTIVES: Differentiating biliary atresia from other causes of neonatal cholestasis is challenging, particularly when cytomegalovirus (CMV) and biliary atresia occur simultaneously. We aimed to elucidate whether CMV infection would affect the differential diagnosis of biliary atresia and intrahepatic cholestasis. PATIENTS AND METHODS: This retrospective study was conducted among patients with neonatal cholestasis admitted to three tertiary hospitals between January 2010 and August 2019. The clinical characteristics, laboratory, and imaging findings were recorded. On the basis of the CMV serology results, the infants were classified into CMV-IgM (+) and CMV-IgM (-) groups. The clinical differences and diagnostic performances of routine predictors between biliary atresia and intrahepatic cholestasis were analyzed in each group. Finally, we compared the diagnostic performances of various tests in the two groups. RESULTS: A total of 705 patients with neonatal cholestasis were enrolled: 215 (30.5%) patients were positive for CMV-IgM, among whom 97 had biliary atresia and 118 had CMV hepatitis; 490 infants were CMV-IgM (-), among whom 240 had biliary atresia and 250 had intrahepatic cholestasis. The diagnostic performances of stool color, direct bilirubin level, γ-glutamyl transpeptidase level, abnormal gallbladder, triangular cord sign, and hepatobiliary scintigraphy between CMV hepatitis and CMV-IgM (+) biliary atresia were similar to those between CMV-IgM (-) biliary atresia and CMV-IgM (-) intrahepatic cholestasis groups. CONCLUSIONS: Our large-scale study showed a high prevalence of CMV infection in patients with neonatal cholestasis in China. The presence of CMV infection did not affect the routine predictors to discriminate biliary atresia and intrahepatic cholestasis.
Subject(s)
Biliary Atresia/diagnosis , Biliary Atresia/microbiology , Cholestasis, Intrahepatic/diagnosis , Cholestasis, Intrahepatic/microbiology , Cytomegalovirus Infections/epidemiology , Biliary Atresia/complications , China , Cholestasis, Intrahepatic/complications , Cytomegalovirus Infections/complications , Cytomegalovirus Infections/diagnosis , Diagnosis, Differential , Female , Humans , Infant, Newborn , Male , Prevalence , Retrospective Studies , Sensitivity and SpecificityABSTRACT
El compromiso hepático es una rara manifestación de la infección por Mycoplasma pneumoniae. Casos de hepatitis colestásica sin compromiso pulmonar han sido descritos en niños con infección por M. pneumoniae, pero en adultos sólo unos pocos casos han sido reportados. En este artículo, presentamos el caso de un hombre de 21 años que consultó por un cuadro de fiebre, ictericia y dolor epigástrico asociado con alteración de los exámenes de laboratorio hepático. Los estudios serológicos de M. penumoniae fueron positivos para IgM e IgG. Los síntomas y exámenes de laboratorio mejoraron completamente luego del tratamiento con claritromicina y ácido ursodeoxicólico.
Liver dysfunction is an unusual manifestation of Mycoplasma pneumoniae infection. Cases of cholestatic hepatitis without pulmonary involvement have been described in children with M. pneumoniae infection,but only a few cases have been reported in adults. In this article, we report the case of a 21-year-old man who presented fever, jaundice and epigastric pain associated with altered liver function tests. Serological tests for M. pneumoniae were positive for IgG and IgM. Clinical symptoms and laboratory tests resolved completely after treatment with clarithromycin and ursodeoxicolic acid. A review of reported cases of liver involvement in M. pneumoniae infection is presented.