Some cases of biliary atresia may occur as a result of infection with cytomegalovirus (CMV).
Proposed mechanism for biliary atresia: direct cytotoxic effect due to the viral infection or immune response
Clinical and pathologic features:
(1) The infant shows the presence of biliary atresia.
(2) The infant is positive for IgM antibody to CMV.
(3) There may be maternal serologic evidence of a recent CMV infection.
(4) A liver biopsy shows a greater degree of inflammation.
(5) Exclusion of other causes of biliary atresia.
Immunostains for CMV performed on the liver biopsy are usually negative.
In many cases of biliary atresia abnormal serum direct bilirubin levels can be detected in the neonate. If the CMV exposure is postnatal then the serum direct bilirubin could be normal.
The overall survival is worse than that seen with CMV-negative infants.
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