721 - Cerebellitis from EBV in a Pediatric Patient

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

AM

Alan Mallouhi, MD

Resident Doctor
Hackensack Meridian JFK Johnson Rehabilitation Institute
emerson, New Jersey, United States

Co-Author(s)

KB

Katherine Bentley, MD

Chief Physiatry
Children's Specialized Hospital/ Rutgers Medical school
Union, New Jersey, United States
SD

Sabrina S. Dieffenbach, MD

Pediatric Rehabilitation Medicine Fellow
Rutgers New Jersey Medical School
Raritan, New Jersey, United States

Submitter(s)

AM

Alan Mallouhi, MD

Hackensack Meridian JFK Johnson Rehabilitation Institute
emerson, New Jersey, United States

Case Diagnosis: Cerebellitis

Case Description: 6-year-old male with no PMH presented with 2-3 days of vomiting. Patient found to be strep positive and was discharged on oral antibiotics. Patient continued to vomit and returned for evaluation. He was started on IV Ceftraxione and Ampicillin, infectious titers collected. During admission, patient was increasingly lethargic with persistent emesis. Workup with MRI brain showed no acute findings, abdominal CT showed splenomegaly, stable since admission. Endoscopic biopsy found mild esophagitis and gastritis with mucosal ulcers. Patient received TPN which resulted in strength and oral tolerance improvement. Patient was stabilized and transferred to pediatric acute rehab for weakness and gait instability. Upon initial rehab assessment he was found to be ataxic with difficulty walking independently, unable to complete Luria bilaterally and severely dysmetric finger to nose and heel to shin. Infectious titers resulted as positive for Epstein-Barr virus. Aforementioned signs and symptoms with positive viral titer is consistent with Cerebellitis

Discussions: This demonstrates a rare cause of cerebellitis from EBV, with negative MRI brain. Cerebellitis is an inflammatory process characterized by cerebellar dysfunction, typically affecting children with infectious history. Epstein-Barr, also known as human herpes virus 4, is a known possible cause of cerebellitis. Cerebellitis can show MRI findings of central necrosis and ring enhancement, however this inflammation is not always seen during the acute infectious stage. Given this patient's positive Epstein-Barr titer, gait unsteadiness, ataxia and vomiting which improved with therapies and supportive management for viral infection, the patient was determined to have cerebellitis.

Conclusions: Cerebellitis from Epstein-Barr Virus is a rare complication that may present without radiological abnormalities. This is an important differential for a patient with vomiting and unsteady gait with signs of infection in order to ensure the patient gets appropriate treatment including physical, speech and occupational therapies. This patient showed significant functional improvement with intensive therapies.