Bowel Colonization by Non-Commensal Fungi in Neonatal Obstructive Cholangitis and Biliary Atresia

Up to two-thirds of biliary atresia (BA) patients need liver transplantation after the standard Kasai portoenterostomy treatment. Unrelenting cholangitis often precedes the full-blown presentation of BA. Using ribosomal 18S sequencing, here we report bowel colonization by non-commensalAspergillusfungi in one case of neonatal obstructive cholangitis. Continuous oral fluconazole treatment resolved obstructive cholangitis completely. Colonization by non-commensalAspergillusandCerrenawere additionally identified in 2 BA cases. In brief, bowel colonization by non-commensal fungi could be a treatable cause of neonatal obstructive cholangitis and potentially BA at an early stage.