Infantile Tremor Syndrome: Response to B12 Therapy

A 1-year-old boy, firstborn to nonconsanguineous parents, presented with loss of acquired developmental milestones and abnormal tremulous movements of his limbs for the past 20 days. The onset followed a period of normal development and was precipitated by an upper respiratory tract infection. On examination, he was underweight (weight: 6.2 kg, <–3 z score); had microcephaly (42 cm, <–3 z score); a plump appearance; a dull, expressionless face; thin, sparse, lightly pigmented hairs (Figure, A); and peripheral hyperpigmentation predominantly over knuckle, elbow, and knee.

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