A Five-Year-Old Boy Diagnosed with an Anti-mGluR1 Positive Post–Streptococcal-Associated Cerebellitis

Background/Purpose: Acute cerebellitis may be infectious, postinfectious, or postvaccination in its etiology and is a rare inflammatory syndrome in children. We report a 5-year-old boy with a presentation of cerebellitis following streptococcal infection who showed truncal ataxia with loss of sitting unsupported; dysarthria; dysmetria; tremor; involuntary facial movements; and small, uncoordinated, jerky movements of the fingers. There was a history of a previous feverish infection with severe nuchal and cervical lymphadenopathy 7 weeks ago, which was treated with oral antibiotics.

Methods: Blood tests, cerebrospinal fluid examination, magnetic resonance imaging and spectroscopy, histochemical, and cytochemical staining were obtained.

Results: Cerebrospinal fluid examination showed lymphocytosis with normal protein and glucose. Magnetic resonance imaging showed diffuse symmetrical swelling and edema of the cerebellum and magnetic resonance spectroscopy indicated cellular inflammation of the cerebellum. Blood tests showed high ASL titer, an increased titer for Anti-DNase B—antibodies and anti-mGluR1 autoantibodies were detected in the cerebrospinal fluid, suggesting that the cerebellum might be injured by postinfectious immunologic reaction.

Conclusion: No examples of acute cerebellitis with an anti-mGluR1 autoantibodies detection have been described yet. Our report supports that streptococcal infections can lead to acute cerebellitis. With physical therapy and early therapeutic intervention, including intravenous immunoglobulin and steroids, we observed a full recovery after 10 weeks.