Infantile cholestasis due to cytomegalovirus infection of the liver. A possible cause of paucity of interlobular bile ducts.

We report a neonatal case of hepatic cytomegalovirus (CMV) infection associated with paucity of interlobular bile ducts. The premature infant developed severe jaundice, and died of disseminated CMV infection. The diagnosis of CMV infection was based on detection of pathognomonic inclusions in the liver and on a high titer of CMV antibody in the serum. The hepatic histologic findings in this infant included severe cholestasis, complete absence of interlobular bile ducts in the majority of the portal tracts, and CMV inclusions in the duct epithelium. Interestingly, the CMV inclusions were localized in the bile duct, but not in the parenchyma. We postulate that the paucity of interlobular bile ducts may have been a sequela of CMV infection of the liver arising from destruction of the bile ducts, leading to severe cholestasis.