Vitamin K Deficiency Associated with Intracranial Bleeding because of Cytomegalovirus Hepatitis in a Breast-Fed Infant Despite the Oral Prophylactic Administration

Abstract

We report here a case of intracranial bleeding in a 54-day-old breast-fed baby with vitamin K deficiency, in spite of the prophylactic administration of three oral doses of vitamin K2. He was anemic and exhibited hyperbilirubinemia and an elevation of serum transaminases and total bile acid. Levels of IgM antibody to cytomegalovirus (CMV) were increased. CMV C7-HRP was detected in his peripheral leukocytes, and CMV-DNA was isolated from his urine and the breast milk of his mother. The results suggested that his cholestatic liver disease resulted from CMV infection, and interfered with the gastrointestinal absorption of the fat-soluble vitamin K. The breast milk of his mother also contained lower levels of vitamin K. The prophylactic administration of oral vitamin K as recommended in Japan did not prevent hemorrhagic complications in this case. The findings demonstrated that it may be important to use alternative protocol to alleviate vitamin K deficiency in neonates with cholestatic liver disease.