A 9-year-old Nepalese boy living in the UK presented with opsoclonus-myoclonus syndrome associated with group A streptococcal infection, and is reported from St Mary's Hospital, London; and University of Southampton, UK. The onset was acute with headache, random eye movements, vomiting, dizziness, photophobia, and jerking of all four limbs. On examination, he had rapid, chaotic eye movements, myoclonus affecting limbs and head, and ataxia. He was empirically treated with ceftriaxone, acyclovir and azithromycin. Neuroblastoma was excluded. Bacterial cultures of blood, urine, and throat swab were negative. CSF contained 18 lymphocytes/ml and 0 neurophils, 0.26 g/L protein, and normal glucose and lactate. CSF culture, per, and viral antibodies were negative. Serum was negative for viral antibodies. Antistreptolysin 0 was 640 units/ml initially and 1600 units/ml at 4 months follow-up. Anti-DNase B was 2880 units/ml on day 1, 1920 u/ml on day 2, and 360 u/ml on day 22. After 2 weeks his eye movements, myoclonus and ataxia had improved. After 4 months he had recovered completely without sequelae. 
COMMENT. Chorea, tics, and obsessive compulsive disorder (PANDAS) have been associated with streptococcal infections. Dyskinesias and associated psychiatric disorders following streptococcal infections are reported in 40 patients in the UK, and opsoclonus or myoclonus was present in 3 . Opsoclonusmyoclonus is parainfectious or a paraneoplastic disorder complicating neuroblastoma.