Ocular Flutter in Scrub Typhus

A 9-year-old boy presented with a subacute febrile illness with bursts of conjugate horizontal saccadic oscillations on visual fixation (Figure and Video; available at www.jpeds.com) and cerebellar ataxia. Examination revealed hepatosplenomegaly and scrotal eschar. Magnetic resonance imaging of the brain was normal and lumbar cerebrospinal fluid showed lymphocytic pleocytosis (70 cells, protein 105 mg/dL). IgM enzyme-linked immunosorbent assay for scrub typhus was positive. Intravenous doxycycline and dexamethasone for 5 days resulted in complete recovery.

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