Infantile tremor syndrome with megaloblastic anaemia – A case series

Infantile tremor syndrome (ITS) is a self-limiting clinical condition primarily affecting infants. It is characterised by a constellation of symptoms, including coarse tremors, often exacerbated by wakefulness and mitigated during sleep, anaemia, distinctive skin pigmentation changes, developmental regression and hypotonia in seemingly well-nourished infants. While a definitive aetiology remains elusive, various hypotheses have been proposed, including infectious, metabolic and nutritional factors. A growing body of evidence implicates Vitamin B12 deficiency as a significant contributor to ITS pathogenesis, though this association remains a subject of ongoing debate. In the absence of a conclusive diagnosis, empirical management often involves a multifaceted approach. Nutritional supplementation with iron, calcium, magnesium, Vitamin B12 and other essential micronutrients is a cornerstone of treatment. Pharmacotherapy, primarily with propranolol, may be employed to alleviate tremors, though other anticonvulsants such as phenobarbital, phenytoin and carbamazepine may be considered in refractory cases.