Phenytoin Intake in Mothers Resulting in Early Onset Infantile Tremor Syndrome in Children: A Report of Two Cases

Abstract

Infantile Tremor Syndrome (ITS) is a complex neurological syndrome that affects exclusively breastfed infants, typically seen between 9 to 12 months of age. However, in the present case, it started at the ages of three months and four months, respectively. ITS is characterised by the presence of megaloblastic anaemia-like features, developmental regression, and the onset of tremors. Here, authors report two cases of ITS, whereby megaloblastic anaemia was present because of drug (phenytoin) intake in mothers. Phenytoin intake in mothers leads to low serum vitamin B12 levels in both the mother as well as the baby. Early onset of ITS in progeny has very rarely reported in the literature. Exclusive breastfeeding is generally considered nutritionally sufficient for infants below six months of age, and the onset of ITS is typically associated with the improper introduction of weaning foods beyond six months. However, in the present cases, although the babies were exclusively breastfed, they developed nutritional deficiencies that manifested as early onset ITS. Phenytoin intake and the associated vitamin B12 deficiency in the mothers are proposed as the causes of this presentation. Such an early presentation is also associated with severe pneumonia and was found to be fatal in one of the two reported causes. The authors would like to make a pertinent point that if pregnant mothers are taking any drugs that can lead to vitamin B12 deficiency, they should ideally be checked with relevant investigations and receive supplements if required, to prevent potentially fatal outcomes in their children.

Keywords

• drug intake
• infancy
• pregnant female
• vitamin b12 deficiency