Ganciclovir treatment in children with cytomegalovirus (CMV)
infection is still controversial and only indicated in selected cases. The aim of thi study was to evaluate clinical and demographic features of CMV
hepatitis in immunocompetent children and to determine the effect of
ganciclovir treatment in these patients retrospectively. The study was carried out in a group o 29 children with CMV
hepatitis. All the patients were investigated for signs of
infection,
inborn errors of metabolism,
genetic diseases,
extrahepatic biliary atresia and other causes of
hepatitis. Two patients with
congenital CMV infection and two patients with
biliary atresia were excluded from the study group. The patients included in the study were divided into two groups: non-cholestatic
hepatitis (n=16) as Group I and cholestatic
hepatitis (n=9) as Group II. Four (25%) patients in the non-cholestatic group and four (44.4 in the cholestatic group were treated with
ganciclovir for a median of 21 days. The mean age was 9.6+/- 10.9 months (median age 6 months) in Group I, while cholestatic
hepatitis patients in Group II were significantly younger, with a mean age of 2.7+/-0.9 months (p<0.01). The most prominent symptoms at admission were
diarrhea and
vomiting (25%) in Group I. In Group I, all cases (100%) and in Group II, three of four cases (75%) treated with
ganciclovir had recovery from acute CMV
hepatitis. In the non-cholestatic group, no relapses were observed while one patient in the cholestatic group relapsed and progressed into chronic
liver disease. Patients who received supportive treatment showed a marked decrease in GGT, ALT, AST and
bilirubin levels spontaneously and no relapses of
hepatitis were observed in at least one year of follow-up. Although
ganciclovir therapy is not indicated particularly in immunocompetent cases, since most were self-limited
infections, in case of progressive and persistent
hepatitis, such as in our cases,
ganciclovir was a treatment option; no side effect due to
ganciclovir therapy was observed in our cases. Although
ganciclovir seems to be effective in progressive CMV
hepatitis, multicenter randomized studies in a large study group are necessar to determine the efficacy and indications for
ganciclovir treatment.