Astrovirus Gastroenteritis Mimicking Necrotizing Enterocolitis in a Pediatric Liver Transplant Recipient: A Case Report and Successful Conservative Management.
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INTRODUCTION: Necrotizing enterocolitis (NEC) is predominantly a disease of premature infants and is rarely in older children. In immunocompromised patients, however, infectious enteritis may present with clinical and radiological findings resembling NEC. In this article, we present a pediatric liver transplant recipient who developed astrovirus-induced gastroenteritis, pneumatous intestinalis, and portal venous gas and was successfully treated without surgery. CASE REPORT: A 24-month-old girl presented with hematochezia 4 months after liver transplantation for hepatoblastoma while receiving tacrolimus, mycophenolate mofetil, and corticosteroid therapy. She had a recent history of diarrhea followed by abdominal distention and lower gastrointestinal bleeding. Imaging studies demonstrated pneumatosis intestinalis and portal venous gas. Blood and stool cultures, Clostridium difficile antigen testing, and respiratory pathogen panels were negative, whereas stool PCR identified astrovirus. Based on the clinical presentation and imaging findings, Bell stage II NEC was diagnosed. The patient was managed conservatively with bowel rest, total parenteral nutrition, broad-spectrum antimicrobial therapy, and temporary adjustment of immunosuppressive treatment. Her bleeding resolved within 48 h, serial imaging showed regression of pneumatosis intestinalis, and she was discharged after 14 days with complete clinical recovery. CONCLUSION: Astrovirus infection should be considered among the potential causes of NEC-like gastrointestinal manifestations in pediatric liver transplant recipients. Although pneumatosis intestinalis and portal venous gas often due to intestinal ischemia, clinically stable transplant recipients may recover with careful monitoring and individualized conservative treatment, avoiding unnecessary surgical intervention.