A new case of opsoclonus-myoclonus syndrome (OMS) secondary to Epstein-Barr virus (EBV) is reported in an adult, and five previously documented cases (3 children, 2 adults) are reviewed from the University of Miami, FL. In the current case, acute onset oscillopsia, tremulousness, and ataxia were preceded by a 10 day history of fever, sore throat, and macular-morbilliform rash. Examination showed multidirectional eye saccades, persisting on eye closure and in sleep, truncal ataxia, and limb myoclonus. Brain MRI and EEG were negative. Head, chest, abdomen and pelvic CT scan and whole-body PET scan were negative. EBV capsid antigen test was positive at 1:640. PCR for EBV genome in the CSF and blood were positive. Methylprenisolone and immunoglobulin IV for 3 to 5 days were without immediate effect, and recovery occurred over 7 weeks. Examination at 1 year follow up was normal. In the 5 previously reported cases of OMS and EBV, none showed EBV in the CSF. [1]

COMMENT. In children OMS is usually a sign of neuroectodermal tumor and rarely is associated with infection. In adults, lung, breast, or pelvic cancer is usually uncovered, and infection occurs in about 20% of cases (authors’ citation of literature). The identification of an infectious cause is rare, and EBS has been reported in only 5 previous cases. A postinfectious or parainfectious process is suggested in the present case with EBV. See Ped Neur Briefs Nov 2001;15:87, for an article on neurobehavioral outcome of OMS.