Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2020; 8(12): 2597-2602
Published online Jun 26, 2020. doi: 10.12998/wjcc.v8.i12.2597
Novel approach for the diagnosis of occult cytomegalovirus cholangitis after pediatric liver transplantation: A case report
Ying Liu, Li-Ying Sun, Zhi-Jun Zhu, Wei Qu
Ying Liu, Zhi-Jun Zhu, Wei Qu, Liver Transplantation Center, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Li-Ying Sun, Intensive Care Unit, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Author contributions: Sun LY conceived and designed the study; Liu Y was involved in concept/design, data collection, data analysis/interpretation, drafting the article and critical revision of the manuscript; Zhu ZJ and Qu W participated in performance of the research; all authors issued final approval for the version to be submitted.
Supported by the Beijing Municipal Science and Technology Commission, No. Z181100001718220.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Li-Ying Sun, MD, PhD, Chief Doctor, Professor, Intensive Care Unit, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Yongan Road No.95, Xicheng District, Beijing 100050, China. sunxlx@outlook.com
Received: March 1, 2020
Peer-review started: March 2, 2020
First decision: April 22, 2020
Revised: May 9, 2020
Accepted: May 21, 2020
Article in press: May 21, 2020
Published online: June 26, 2020
Processing time: 114 Days and 20.8 Hours
Abstract
BACKGROUND

Cytomegalovirus (CMV) infection is a common infection in liver transplant recipients, which is related to chronic rejection and biliary complications. It is often diagnosed based on serum CMV-DNA or CMV pp65. To our knowledge, this is the first report of the successful treatment of occult CMV cholangitis in a pediatric liver transplantation (LT) recipient.

CASE SUMMARY

A 7-mo-old baby girl received LT due to biliary atresia and cholestasis cirrhosis. At 1 mo following LT, the patient suffered from aggravated jaundice with no apparent cause. As imaging results showed intrahepatic and extrahepatic bile duct dilatation, the patient was diagnosed with biliary complications and percutaneous cholangiography and biliary drainage was performed. However, there was little biliary drainage and her liver function deteriorated. CMV-DNA was isolated from the bile with the surprising outcome that 3 × 106 copies/mL were present, whereas the CMV-DNA in serum was negative. Following antiviral therapy with ganciclovir, she gradually recovered and bilirubin decreased to normal levels. During the 4-year follow-up period, her liver function remained normal.

CONCLUSION

Bile CMV sampling can be used for the diagnosis of occult CMV infection, especially in patients with negative serum CMV-DNA and CMV pp65. Testing for CMV in the biliary tract may serve as a novel approach for the diagnosis of cholestasis post-LT. Timely diagnosis and treatment will decrease the risk of graft loss.

Keywords: Occult cytomegalovirus cholangitis; Biliary complications; Pediatric; Liver transplantation; Bile cytomegalovirus-DNA detection; Case report

Core tip: Cytomegalovirus (CMV) is related to chronic rejection and biliary complications that can occur after liver transplantation. Although often treated prophylactically, CMV infection and CMV disease still remain a challenge. Here we report the successful treatment of occult CMV cholangitis in a pediatric liver transplantation recipient. Our study suggests that testing for CMV in the biliary tract especially in patients with negative serum CMV-DNA and CMV pp65 may be a novel approach for the diagnosis of occult CMV cholangitis after pediatric liver transplantation. Timely diagnosis and treatment will decrease the risk of graft loss.