Intrahepatic Cholestasis due to Cytomegalovirus Infection and Extrahepatic Cholestasis due to Sludge Bile with Confirmed COVID-19

Background: Human Cytomegalovirus (CMV) is a Beta-Herpes virus that leads to congenital infection in 0.4% 2,3 % of all newborns. Diagnosis CMV includes the culture nasopharynx, saliva, and urine. Serologic tests are also beneficial for diagnosis. IgM CMV-specific antibodies can be monitored. Biliary sludge mixture particulate solids have precipitated from bile. Laparoscopic cholecystectomy offers most definitive therapy biliary sludge.
 Case presentation: A 2-month-old boy complained yellow appearance since age 1 week ago. Looks pale. Defecation was sometimes colored putty 2 weeks. Blood laboratory examination with hemoglobin 8,7 gr/dL, Prothrombin time, activated partial thromboplastin liver function were increased. Bilirubin, alkaline phosphatase, Gamma GT Two-phase abdominal USG atresia. PCR urine blood sample positive. Head consistent infection. Cholangiography showed bile cirrhosis. Therapy gansiklovir IV 14 days then per oral 6 months.
 Conclusion: diagnosis sludge. causes asymptomatic multiple severe symptoms, so it necessary monitor children adherence treatment, improve nutritional status reduce morbidity mortality rates.