Acute-onset Ataxia – An Atypical Presentation of Leptospirosis

Neurological leptospirosis commonly manifests as aseptic meningitis. Cerebellar involvement is rare, affecting only about 5% of cases. We report the case of a 27-year-old male with a history of fever, chills, vomiting, severe headache, neck pain, photophobia, and acute onset ataxia. On clinical examination, cerebellar signs were positive, with a broad-based ataxic gait. All other causes of cerebellitis were ruled out, with Magnetic resonance imaging showing no significant abnormalities. Leptospira serology revealed elevated titers of immunoglobulin M antibodies. The patient was started on intravenous third-generation cephalosporin and doxycycline, alongside physiotherapy. There was significant improvement with treatment, and a complete reversal of cerebellar signs was noted on subsequent follow-up.