Ganciclovir treatment in infants with cytomegalovirus infection and cholestasis.
BACKGROUND
The authors have previously described an association between cytomegalovirus (CMV) infection and intrahepatic and extrahepatic forms of neonatal cholestasis. Pediatric use of the antiviral drug ganciclovir to treat patients with CMV infection has increased. In this study, infants with CMV infection and cholestasis were treated with ganciclovir.


METHODS
Six infants with cholestasis (age, 3-16 weeks) and with signs of ongoing CMV infection were treated with intravenous ganciclovir for 3 to 7 weeks and observed for 4 to 31 months after treatment. Two patients had biliary atresia, one had suspected septo-optic dysplasia and three had no obvious cause for intrahepatic cholestasis other than ongoing CMV infection.


RESULTS
Four patients, including one with biliary atresia, responded to the treatment, whereas two patients, including the one with septo-optic dysplasia did not. The latter patient had episodes of symptomatic hypoglycemia during the treatment, which was subsequently stopped. Liver function at the end of follow-up was good in four patients, intermediate in one, and poor in one.


CONCLUSIONS
Ganciclovir treatment may be beneficial in infants with CMV-associated intrahepatic cholestasis, but controlled studies are needed. Because of the possible side effect of hypoglycemia, infants with cholestasis who have increased risk for such episodes should not be treated.
Fischler
Björn
B
Department of Pediatrics, Huddinge University Hospital, Karolinska Institutet, Stockholm, Sweden. bjorn.fischler@pediat.hs.sll.se
Casswall
Thomas H
TH
Malmborg
Petter
P
Nemeth
Antal
A
D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002675:Child, Preschool; D002779:Cholestasis / Q000150:complications / Q000188:drug therapy*; D003586:Cytomegalovirus Infections / Q000150:complications / Q000188:drug therapy*; D005260:Female; D015774:Ganciclovir / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007223:Infant; D007231:Infant, Newborn; D007275:Injections, Intravenous; D008099:Liver / Q000473:pathology / Q000821:virology; D008111:Liver Function Tests; D008137:Longitudinal Studies; D008297:Male; D016896:Treatment Outcome
D000998:Antiviral Agents; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D015774:Ganciclovir