Pediatric Opsoclonus-Myoclonus Ataxia Syndrome (OMAS) Following Scrub Typhus: A Case Series

A bstract Opsoclonus-myoclonus ataxia syndrome (OMAS) poses diagnostic challenges, particularly in pediatric cases, where post-infectious etiology remains underrecognized. This series presents a retrospective chart review of pediatric OMAS following scrub typhus, a novel contribution from India. Thirty OMAS cases were analyzed, with four cases linked to scrub typhus (1.3%). The mean onset of neurological symptoms occurred 9.5 days post-scrub typhus onset, affecting children aged 7–10 years. Clinical presentations varied, with one patient exhibiting multi-systemic involvement and another showing cerebral and cerebellar atrophy on magnetic resonance imaging. Lymphocytic pleocytosis characterized cerebrospinal fluid findings. Treatment comprised doxycycline and short-term intravenous methylprednisolone followed by oral steroids, yielding significant improvement in Mitchell-Pike scores. Early diagnosis and treatment initiation were emphasized, as delays led to adverse outcomes. Notably, post-infectious OMAS necessitates brief immunotherapy and offers favorable prognoses if managed promptly. This study underscores the importance of considering post-infectious etiology in pediatric OMAS, advocating for heightened awareness and early intervention.