Acute necrotizing encephalopathy associated with COVID-19 in a pediatric patient and a systematic review.

Publication date: Mar 02, 2026

Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, can lead to neurological complications such as acute necrotizing encephalopathy (ANE). However, the pathogenesis of ANE associated with COVID-19 remains unclear. We report a case of ANE associated with COVID-19 and then conducted a literature review using PubMed for cases reported up to June 30, 2024. Clinical data from 74 patients were analyzed. Among those with severe sequelae (n = 28), 39. 2% (n = 11) had hemorrhagic findings on CT or MRI, significantly more than in the mild sequelae group (10. 8% [n = 5], P = 0. 04). 16 patients underwent genetic testing for RANBP2 mutations, of whom four (25%, n = 16) tested positive. These findings suggest that imaging evidence of hemorrhage may be a poor prognostic factor and that RANBP2 mutations could contribute to disease susceptibility. Further genetic studies involving larger cohorts are needed to better understand the mechanisms of ANE associated with COVID-19 and improve outcomes for affected patients.

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Concepts	Keywords
Coronavirus	Acute
Hemorrhage	Ane
June	Clinical
Mild	Covid
Mri	Encephalopathy
	Findings
	Genetic
	Mutations
	Necrotizing
	Patient
	Pediatric
	Ranbp2
	Review
	Sequelae
	Systematic

Semantics

Type	Source	Name
disease	MESH	COVID-19
disease	MESH	hemorrhage
disease	MESH	disease susceptibility
drug	DRUGBANK	Tropicamide
disease	MESH	pneumonia
disease	MESH	fever
disease	MESH	cough
disease	MESH	dyspnea
disease	MESH	neurological disorders
disease	MESH	cerebrovascular disease
disease	MESH	encephalitis
disease	MESH	meningitis
disease	MESH	anosmia
disease	MESH	lethargy
disease	MESH	Guillain Barre syndrome
disease	MESH	syndrome
disease	MESH	encephalopathy
disease	MESH	viral infections
disease	MESH	influenza
disease	MESH	parainfluenza
disease	MESH	varicella
disease	MESH	zoster
disease	MESH	herpes simplex
disease	MESH	measles
pathway	KEGG	Measles
disease	MESH	cytokine storm
disease	MESH	brain edema
drug	DRUGBANK	Ranitidine
disease	MESH	severe acute respiratory syndrome
disease	MESH	strain
drug	DRUGBANK	Trestolone
drug	DRUGBANK	Immune Globulin Human
drug	DRUGBANK	Edaravone
drug	DRUGBANK	Mannitol
disease	MESH	brain death
disease	MESH	hypotension
disease	MESH	polyuria
disease	MESH	hypothyroidism
disease	MESH	renal insufficiency
disease	MESH	central diabetes insipidus
disease	MESH	adrenal insufficiency
disease	MESH	hypopituitarism
drug	DRUGBANK	Desmopressin
drug	DRUGBANK	Hydrocortisone
disease	MESH	necrosis
drug	DRUGBANK	Urea
drug	DRUGBANK	Nitrogen
drug	DRUGBANK	Creatinine
disease	MESH	image
disease	MESH	included
disease	MESH	mRS
disease	MESH	infection
disease	MESH	multiple organ failure
disease	MESH	death
disease	MESH	seizures
disease	MESH	dis
disease	MESH	clinical course
disease	MESH	Noma
disease	MESH	Viral encephalitis
disease	MESH	hemophagocytic syndrome
disease	MESH	Park
disease	MESH	ANE1
disease	MESH	Acute necrotizing encephalitis
disease	MESH	aplastic anemia
disease	MESH	cognitive impairment
disease	MESH	vascular disease
disease	MESH	inflammation
disease	MESH	acute disseminated encephalomyelitis
disease	MESH	Parkinsonism
disease	MESH	encephalomyelitis
drug	DRUGBANK	Tocilizumab
disease	MESH	liver cirrhosis
disease	MESH	coronavirus infection
disease	MESH	Recurrent infection
disease	MESH	dysphagia
disease	MESH	ataxia
drug	DRUGBANK	Guanosine
disease	MESH	Neurological manifestations
disease	MESH	Chai
pathway	REACTOME	Glucose metabolism