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

## TL;DR

This paper reports a severe and often fatal SARS-CoV-2-related condition in children involving brain swelling and organ failure across Asia and Oceania from 2022 to 2024.

## Contribution

The study identifies a new, rapidly progressive SARS-CoV-2-associated encephalopathy with high mortality in children.

## Key findings

- 22 out of 25 children with the condition died, with 44% dying within 24 hours of hospitalization.
- 72% of patients developed shock, and 56% experienced multiorgan failure within 6 hours of neurological symptoms.
- Elevated levels of cytokines like interleukin 6 and tumor necrosis factor-α were observed in affected children.

## Abstract

SARS-CoV-2 infections in children occasionally manifest with severe neurologic signs. We report a case series of life-threatening encephalopathy associated with SARS-CoV-2 in 25 children in Australia, Japan, Singapore, and Taiwan during February 2022–January 2024. All children had severe encephalopathy develop, characterized by rapidly progressive cerebral edema, conditions known as acute shock with encephalopathy and multiorgan failure or acute fulminant cerebral edema. Among the 25 patients, 22 (88%) eventually died; 11 (44%) children died within 24 hours of hospitalization. In addition, 18 (72%) had illness manifest with shock, and 14 (56%) had multiorgan failure develop within 6 hours of neurologic onset. Serum concentrations of cytokines/chemokines including interleukin 6 and tumor necrosis factor-α were significantly higher within 24 hours of onset than for controls. SARS-CoV-2–associated encephalopathy cases such as those described here represent an emerging neurologic crisis with high mortality rate resulting from rapidly progressive brain edema and multiorgan failure.