Cytomegalovirus in biliary atresia: coincidental or causal?

Introduction  Neonatal cholestasis (NC) has been documented in 19–33% of neonates with chronic liver disease attending tertiary care hospitals in India1-3. Of these, almost one third have been attributed to biliary atresia3. Cytomegalovirus (CMV) is known to cause intrahepatic bile duct paucity and destruction and has been suggested to cause extra hepatic biliary atresia (EHBA) in a few case series4. We present a series of 4 cases admitted to our hospital over the last 18 months having EHBA with CMV infection.