Ascites and neonatal cholestasis: a successful steroid therapy

Introduction. Neonatal cholestasis is caused by surgical or medical conditions, and its management must be prompt to improve patient outcomes. Case presentation. A 3-month-old baby boy presented with complaints of prolonged jaundice and acholic stool. There was anemia (Hb 8.6 g/dL), thrombocytopenia (79 × 10³/µL), elevated hemostasis function (PPT 23.8 seconds and APTT 48.1 seconds), increased liver enzymes (AST 23.8 U/L, ALT 138 U/L, and Gamma GT 354.6 U/L), cholestasis (total bilirubin 18.21 mg/dL and direct bilirubin 12.92 mg/dL), CMV IgG Reactive (59.6 AU/mL), and CMV IgM reactive at 2.81 index (<0.85). A two-phase abdominal ultrasound revealed splenomegaly and ascites. After steroid therapy, there was clinical and laboratory improvement with bilirubin within normal limits. The patient was free of jaundice and ascites. Conclusion. In neonatal cholestasis, a thorough investigation and CMV screening are necessary to determine treatment. However, steroid treatment may be an alternative for cholestasis in health facilities with limited resources.