Neonatal rotavirus encephalopathy with white matter injury: A case report

Rotavirus is a well-recognised cause of gastroenteritis in infants but has increasingly been linked to neurological complications in neonates. We report a 35-week preterm male neonate, the second twin of an in vitro fertilisation pregnancy, who was readmitted on day 9 of life with lethargy and hypotonia in the absence of fever, diarrhoea, or perinatal asphyxia. Brain MRI on diffusion-weighted imaging (DWI) demonstrated bilateral periventricular and deep white matter diffusion restriction resembling periventricular white matter injury seen in preterm infants with hypoxic-ischaemic encephalopathy. A comprehensive septic, metabolic, and congenital screen was negative. Electroencephalography (EEG) was normal. Stool polymerase chain reaction (PCR) for rotavirus returned positive on day 15, establishing the diagnosis of rotavirus-associated leukoencephalopathy. The infant was managed supportively with empirical antibiotics (subsequently discontinued) and antiseizure medications (ASMs) for clinically suspected seizure-like events. He showed gradual clinical improvement and was discharged on day 17 in a stable condition with outpatient neurodevelopmental follow-up arranged. This case highlights the importance of including rotavirus stool testing in the evaluation of neonates with unexplained encephalopathy and a characteristic DWI white matter injury pattern, even in the absence of gastrointestinal symptoms. Early identification prevents diagnostic delay, avoids unnecessary interventions, and enables appropriate neurodevelopmental surveillance.