Acute Necrotizing Encephalopathy Associated With SARS-CoV-2 Exposure in a Pediatric Patient

We present the case of a nine-month-old male child with three days of fever, irritability, left focal seizure, and febrile focal status epilepticus. He had no history of previous comorbidities. A lumbar puncture was performed, which showed cerebrospinal fluid (CSF) leukocytosis; protein and glucose were normal, and the polymerase chain reaction (PCR) panel for 14 pathogens in CSF was negative. Immunoglobulin G (IgG) qualitative and quantitative tests were positive for coronavirus disease 2019 (COVID-19) upon arrival. An MRI performed one week after the initial onset showed findings suggestive of acute necrotizing encephalopathy (ANE). The patient required mechanical ventilation. However, his symptoms did not improve and follow-up imaging two weeks later showed progression of the disease with hemorrhagic changes. To our knowledge, this is the first reported case of ANE associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-​2) infection in a pediatric patient.