Abstract Ref Number = APCP1064
EARLY-ONSET NEONATAL SEPSIS DUE TO BILIARY SLUDGE A CASE REPORT OF NEONATAL CHOLESTASIS
Dhea Rachmawati,Ivan Onggo Saputro
Krakatau Medika Hospital
Background : Cholestasis is bile flow impairment characterized by direct hyperbilirubinemia. To the best of our knowledge, lack of studies addressing neonatal sepsis with biliary sludge specifically.
Case Presentation Summary : An Indonesian boy aged 5 days was admitted to Emergency Room as a case of jaundice since his birth. He was born by C-section delivery with small for gestational age. On examination, we found sepsis criteria, jaundice, and hepatosplenomegaly. The laboratory investigations showed anemia, thrombocytopenia, leukocytosis, and shift to the left on differential blood count. The liver function showed total bilirubin of 35,9 mg/dL, direct bilirubin of 22,7 mg/dL, and elevated liver enzyme. Blood glucose, Glucose-6-Phosphate Dehydrogenase (G6PD) quantitative, and Thyroid-Stimulating Hormone were in normal range. Hepatitis B surface antigen was undetectable. Urinary laboratory test detected nitrites. Ultrasonograhy showed cholecystitis with gallbladder sludge. The patient was diagnosed as cholestasis with early-onset neonatal sepsis and urinary tract infection. He has been managed by ursodeoxycholic acid, fat-soluble vitamin, cefotaxime, and amikacin.
Learning Points/Discussion : Causes of neonatal cholestasis are multifactorial with biliary sludge representing a rare etiology. This case showed both of infection and obstruction were possible to cause cholecystitis. Biliary sludge has been reported in association with metabolic disorders, biliary malformation, hormonal effect, and medication effect. We ruled out galactosemia, hypothyroidism, G6PD deficiency, Allagile syndrome, bile stricture, and total parenteral nutrition. Certain medications including fluconazole, ceftriaxone, and cefotaxime are found associated with developing biliary sludge, but not in our case. Endotoxemia in sepsis causes hepatocyte transport impairment leading to intrahepatic cholestasis. Urinary tract infection also causes intrahepatic cholestasis. We concluded the cholestasis in our patient caused by multifactorial origin. We suggest that another unknown mechanism in neonatal sepsis might causes biliary sludge that affect cholestasis. Further study may be required to explore the association is merely incidental or describes a new phenomenon.
Keywords: Neonatal cholestasis Neonatal sepsis Biliary sludge