Neonatal Cholestasis Due to Biliary Sludge- Review and Report of a Case Associated with Use of Diflucan

Causes of neonatal cholestasis are varied and complex with biliary sludge representing a rare etiology. Biliary sludge has been reported in association with metabolic disorders, biliary malformation, hormonal effect, and medication effect amongst others. Herein we report a case of cholestasis secondary to biliary sludge associated with recent use of diflucan (fluconazole). An infant presented on the 85th day of life with jaundice, weight loss, hepatosplenomegaly and recent acholic stools. His clinical history was significant for diflucan therapy one month prior. On presentation, patient’s total bilirubin, alkaline phosphatase, and gamma-Glutamyl transpeptidase were elevated. Cholangiography showed biliary ductal dilatation with obstructing debris. There was no evidence of cystic malformation. Trans-catheter irrigation of the biliary tree, cholecystectomy, and biopsy of liver were performed. The gallbladder and cystic duct were unremarkable, save for mural bile deposition on histology. Liver biopsy had canalicular cholestasis, mild ductular proliferation, and was otherwise unremarkable; there was no ultra-structural anomaly. Clinic-pathologic work ups for screening infectious, metabolic and heritable disease were unremarkable. Few days post-op, bilirubin levels and liver function tests normalized; repeat ultrasounds showed a normal-caliber biliary tree. The patient’s follow up 7 months after presentation remains unremarkable.