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Cases of acute disseminated encephalomyelitis (ADEM) and its hyperacute form, acute hemorrhagic leu-koencephalitis (AHLE), have been reported in coronavirus disease 2019 (COVID-19) patients as rare, but most severe neurological complications. However, histopathologic evaluations of ADEM/AHLE pathology in COVID patients are extremely limited, so far having only been reported in a few adult autopsy cases. Here we com-pare the findings with an ADEM-like pathology in a pediatric patient taken through a biopsy procedure. Un-derstanding the neuropathology may shed informative light on the autoimmune process affecting COVID-19 patients and provide critical information to guide the clinical management.