ObjectiveTo describe a novel case of coronavirus disease 2019 (COVID-19)-associated acute necrotizing encephalopathy (ANE) in a patient with aplastic anemia where there was early brain stem-predominant involvement.MethodsEvaluation of cause, clinical symptoms, and treatment response.ResultsA 59-year-old woman with a background of transfusion-dependent aplastic anemia presented with seizures and reduced level of consciousness 10 days after the onset of subjective fever, cough, and headache. Nasopharyngeal swab testing for severe acute respiratory syndrome coronavirus (SARS-CoV-2) was positive, and CT during admission demonstrated diffuse swelling of the brain stem. She required intubation and mechanical ventilation for airway protection, given her reduced level of consciousness. The patient's condition deteriorated, and MRI on day 6 demonstrated worsening brain stem swelling with symmetrical hemorrhagic lesions in the brain stem, amygdalae, putamina, and thalamic nuclei. Appearances were consistent with hemorrhagic ANE with early brain stem involvement. The patient showed no response to steroid therapy and died on the eighth day of admission.ConclusionsCOVID-19 may be associated with an acute severe encephalopathy and, in this case, was considered most likely to represent an immune-mediated phenomenon. As the pandemic continues, we anticipate that the spectrum of neurologic presentation will broaden. It will be important to delineate the full clinical range of emergent COVID-19-related neurologic disease.

There are very limited published data on the neurologic complications associated with coronavirus disease 2019 in the pediatric population. Here we present the first 2 pediatric cases of presumed COVID-19 related cytotoxic lesions of the corpus callosum. Similar to reports in adults, these cases suggest that the COVID-19 infection in children may rarely mediate a hyperinflammatory response that can cause CNS pathology. As the pandemic continues further, the presentation of cytotoxic lesions of the corpus callosum should prompt radiologists to consider COVID-19, among other known causes. ABBREVIATIONS: CLOCC¼ cytotoxic lesions of the corpus callosum; COVID-19 ¼ coronavirus disease 2019; CRP ¼ C-reactive protein; RT-PCR ¼ real-time reverse transcriptase polymerase chain reaction; SARS-CoV-2 ¼ Severe Acute Respiratory Syndrome coronavirus 2A s of June 2, 2020, over 6.1 million cases of coronavirus disease 2019 (COVID-19) have been recorded and over 370,000 people have died. 1 Most confirmed cases have been in the adult population with only a small percentage (1%-2%) of reported cases being in children. 2 In the pediatric population, COVID-19 infection seems to be often asymptomatic or associated with mild respiratory symptoms. 2 As yet, there have been very limited reports of neurologic complications in children. Here we report the first series of pediatric neurologic presentations with COVID-19-associated cytotoxic lesions of the corpus callosum (CLOCC). This presentation has been related to other viral infections, but not yet demonstrated in association with COVID-19.