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Volume 32, Number 2—February 2026

Synopsis

Life-Threatening SARS-CoV-2–Associated Encephalopathy and Multiorgan Failure in Children, Asia and Oceania, 2022–2024

Mariko Kasai1, Hiroshi SakumaComments to Author , Motomasa Suzuki1, Masahiro Nishiyama1, Nanako Kawata1, Jainn-Jim Lin1, Kuang-Lin Lin, Velda Han, Shekeeb S. Mohammad, Russell C. Dale, Terrence Thomas, Kazuhiro Muramatsu, Osamu Mitani, Yoshiyuki Kobayashi, Kouhei Ishida, Yuichi Abe, Ichiro Kuki, and Jun-ichi Takanashi
Author affiliation: Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan (M. Kasai, H. Sakuma); Aichi Children's Health and Medical Center, Aichi, Japan (M. Suzuki); Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan (M. Nishiyama); Tokyo Metropolitan Children’s Medical Center, Tokyo (N. Kawata); Chang Gung Children’s Hospital and Chang Gung Memorial Hospital, School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan (J.-J. Lin, K.-L. Lin); Khoo Teck Puat-National University Children’s Medical Institute, Singapore (V. Han); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (V. Han); Kids Neuroscience Centre, The Children’s Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia (V. Han, S.S. Mohammad, R.C. Dale); KK Women’s and Children’s Hospital, Singapore (T. Thomas); Jichi Medical University, Tochigi, Japan (K. Muramatsu); Fukuyama City Hospital, Hiroshima, Japan (O. Mitani); Hiroshima University Hospital, Hiroshima (Y. Kobayashi); Sapporo Medical University School of Medicine, Sapporo, Japan (K. Ishida); National Center for Child Health and Development, Tokyo (Y. Abe); Osaka City General Hospital, Osaka, Japan (I. Kuki); Tokyo Women’s Medical University Yachiyo Medical Center, Chiba, Japan (J. Takanashi)

Main Article

Table 1

Clinical characteristics of patients with SARS-CoV-2 ASEM/AFCE in study of life-threatening SARS-CoV-2–associated encephalopathy and multiorgan failure in children, Asia and Oceania, 2022–2024*

Patient no. Age Hours from onset of fever to neurologic symptoms GCS at onset Brain CT/MRI Outcome by PCPC† Hours from onset of neurologic symptoms
To RA To CA
1 10 mo 10 E1V1M1 DCE 6 <6 >48
2 10 mo 48 NA DCE, focal abnormality 6 NA NA
3 1 y 6 mo 19 E4V3M4 DCE 6 NA NA
4 1 y 10 mo 14 NA DCE 5 >48 –
5 2 y 16 E1V1M1 DCE 6 <6 <6
6 2 y NA E1V1M1 DCE 6 6–12 >48
7 2 y 4 mo 5 E1V1M1 DCE 5 >48 –
8 2 y 4 mo 12 E1V1M1 DCE 6 At onset At onset
9 2 y 7 mo 12 E1V1M3 DCE, BTA 6 NA NA
10 2 y 7 mo 24 E1V2M1 DCE 6 <6 >48
11 2 y 8 mo 15 E1V1M3 DCE 6 6–12 >48
12 2 y 9 mo NA E2V2M3 DCE 6 <6 <6
13 2 y 11 mo 27 E2V1M3 DCE 6 >48 >48
14 3 y 2 mo 20 E1V2M4 DCE 6 <6 <6
15 3 y 9 mo 5~10 E1V1M4 DCE, focal abnormality 6 NA NA
16 4 y NA NA DCE 6 >48 >48
17 4 y NA E1V1M1 DCE 6 <6 <6
18 6 y 7 mo 10 E3V2M5 DCE 1 – –
19 7 y 4 mo 9.5 E1V1M4 DCE 6 NA >48
20 7 y 7 mo 18 E1V1M1 DCE 6 24–48 >48
21 8 y 1 mo 20 E1V2M1 DCE 6 24–48 24–48
22 8 y 6 mo NA E1V1M1 DCE 6 <6 <6
23 8 y 9 mo NA E2V3M4 DCE 6 <6 ≥48
24 8 y 9 mo 2 E1V1M1 DCE 6 <6 <6
25 10 y 2 mo 12 NA DCE 6 6–12 >48

*AFCE, acute fulminant cerebral edema; ASEM, acute shock with encephalopathy and multiorgan failure; BTA, bright tree appearance; CA, cardiac arrest; DCE, diffuse cerebral edema; GCS, Glasgow Coma Scale; NA, not available; PCPC, pediatric cerebral performance category; RA, respiratory arrest; –, not applicable. †Outcome was graded as follows: presymptomatic state (PCPC = 1), mild disability (PCPC = 2), moderate disability (PCPC = 3), severe disability (PCPC = 4), coma or vegetative state (PCPC = 5), and death (PCPC = 6).

Main Article

1These authors contributed equally to this article.

Page created: January 22, 2026
Page updated: February 09, 2026
Page reviewed: February 09, 2026
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