Infantile Tremor Syndrome: A Case Series

Infantile tremor syndrome (ITS) is a rare clinical disorder characterized by coarse tremors, anemia, and regression/delay of development in children around 6 months to 1 year of age belonging to poor socioeconomic strata and on milk-based diet. It accounts for 0.2 to 2% cases in India. No conclusive etiology has been ascertained so far. Nutritional deficiency (like vitamin B12, magnesium, vitamin C, zinc) is the most accepted association. We report six such cases that presented to our hospital with the classical neurological, dermatological, and hematological findings of ITS. Investigations revealed all cases to be vitamin B12 deficient. Two of our cases had corticocerebral atrophy on neuroimaging. One case expired due to respiratory failure due to severe pneumonia. Others were treated with vitamin B12 injections. Other nutrients like iron, zinc, folic acid, and magnesium were also supplemented. Routine follow-up of these cases showed gradual improvement in clinical, hematological, and neurological parameters. Although rare, ITS should be considered in any infant presenting with anemia, malnutrition, developmental delay, hyperpigmentation, and tremors. Early treatment can prevent neurological sequelae as it is largely a preventable disease. Regular follow-up is helpful to evaluate response to treatment.