A previously healthy 5-year-old girl develops generalized pruritic vesicles in crops, some crusted, with fever for 2 days. Her mother notes the lesions began on the trunk. On day 4 she develops gait ataxia and nystagmus but has no headache or altered sensorium. What is the MOST likely neurological complication?

• A Reye syndrome
• B Transverse myelitis
• C Guillain-Barre syndrome
• D Acute cerebellar ataxia ✓

Explanation

Acute cerebellar ataxia is the most common central nervous system complication of varicella in children, appearing 5 to 10 days after the rash with ataxia and nystagmus, usually benign and self-limiting. Transverse myelitis and Guillain-Barre are rarer varicella-related neurologic syndromes. Reye syndrome follows aspirin use in influenza or varicella and presents with encephalopathy and hepatic failure, not isolated ataxia.

Reference: Nelson Textbook of Pediatrics, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.