To describe the occurrence of acute cerebellar ataxia after COVID-19 infection in a 5-year-old boy.

A 5-year-old boy with type I diabetes mellitus was exposed to a COVID-19 positive classmate in school. He tested positive for the SARS-CoV-2 virus and developed mild symptoms including rhinorrhea and decreased energy.  Eight days later he developed acute ataxia, double vision, tremor and dysmetria. He was admitted to the hospital for further evaluation.

He had hyperglycemia at presentation, however labs were not consistent with diabetic ketoacidosis. Nasopharyngeal swab for SARS-CoV-2 was positive by polymerase chain reaction, and SARS-CoV-2 IgG nucleocapsid antibody testing was positive in serum. Cerebrospinal fluid showed white blood cells 8 cells/uL, red blood cells 0 cells/uL, protein 20 mg/dL and glucose 110 mg/dL. Other infectious testing in the CSF was negative including CSF testing for SARS-CoV-2. Brain magnetic resonance imaging with and without contrast was normal. The patient was treated with supportive care and discharged home after 4 days. Symptoms gradually improved and resolved at 2 month follow up.

Acute cerebellar ataxia can be seen in children, often following a viral infection. Rare reports have described acute ataxia in adults recovering from COVID-19. Only one case report has previously described acute cerebellar ataxia in a pediatric patient of 13 years (Tomar et al 2021). Providers should be aware of acute cerebellar ataxia as a possible sequela in pediatric patients recovering from COVID-19.