Severe Acute Respiratory Syndrome Corona Virus 2 (SARS CoV-2) an ongoing pandemic has affected over 200 million people worldwide and caused over 4.5 million deaths. COVID-19 related acute encephalopathy has been known to exist and is thought to be multifactorial, most often related to underlying systemic inflammation, ischemic strokes, hypoxic injury or direct viral invasion and is associated with increased mortality.

We report a case series of three young patients with acute necrotizing hemorrhagic encephalitis (ANHE) after COVID-19 infection and a review of literature. Two of the cases (without preexisting comorbidities) had self-limiting disease that improved with resolution of systemic illness, and one (with preexisting comorbidities) had pathological evidence of fungal invasion who improved only after antifungal therapy.

Acute necrotizing hemorrhagic encephalitis is a potential complication of COVID-19 and is multifactorial, mediated by cytokines, host inflammatory response, superimposed infections, hypoxemia, hypercoagulability and possibly direct viral invasion. Clinical course may range from mild self-limiting illness to severe encephalitis with co-infection with other pathogens. Low threshold for neuroimaging, even with mild neuropsychiatric symptoms like headaches, can help in early diagnosis and prompt management, potentially preventing further complications.