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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 3

Cases of SARS-CoV-2 ASE/AFCE reported in the literature from scoping review for study of life-threatening SARS-CoV-2–associated encephalopathy and multiorgan failure in children, Asia and Oceania, 2022–2024*

Country and reference
 Patient age
 First symptoms with fever
 Brain CT/MRI
 Outcome by PCPC†
 Times from 
onset to CA
United States (6)
 7 y
Headaches, abdominal pain, and emesis
 DCE
 6
 NA
United States (7) <1 y Gastrointestinal symptoms 
and status epilepticus DCE 6 <24 h
6–12 y Status epilepticus DCE and herniation 6 3rd day of admission
6–12 y Status epilepticus DCE and herniation 6 48 h of admission
3–5 y
Altered awareness, seizure, vomiting, acute respiratory failure, and shock
 DCE
 NA
 NA
United States (14)
 8 y
Lethargy, myalgias, anorexia, and seizure
 DCE
 6
 NA
Tunisia (15)
 2 mo
 Poor feeding and sleep, seizure, and shock
 DCE
 6
 12 h
India (16)
 10 y
Repetitive seizures and encephalopathy
 DCE and herniation
 6
 14th day of admission
United States (17) 13–17 y NA NA 6 NA
13–17 y
NA
 NA
 6
 NA
South Korea (18) 11 y Status epilepticus DCE 6 14th day of admission
9 y Status epilepticus DCE 6 NA

*AFCE, acute fulminant cerebral edema; ASEM, acute shock with encephalopathy and multiorgan failure; CA, cardiac arrest; CT, computed tomography; DCE, diffuse cerebral edema; MRI, magnetic resonance imaging; NA, not available; PCPC, pediatric cerebral performance category. †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

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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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