A 15-year-old girl without any premorbid medical or surgical illness was brought to our hospital with complaints of fever and drowsiness of 2 days duration. She had a history of fever with multiple cervical lymph node enlargement 2 weeks ago, for which she was treated outside with oral levofloxacin 500 mg once daily for 1-week. On examination, the patient was drowsy. She was febrile. Bilateral cervical lymphadenopathy was present involving a posterior group of cervical lymph nodes. Neurological examination showed vertical gaze palsy with bilateral horizontal gaze-evoked nystagmus. Blepharospasm was present [Videos 1 and 2]. Convergence was impaired in both eyes. Fundus examination was normal. Slit lamp examination did not show any evidence of Kayser-Fleischer ring. No focal motor deficits were noted. Bilateral knee and ankle jerks were sluggish with bilateral extensor plantar. Bilateral cerebellar signs and gait ataxia were present. Meningeal signs were present. Laboratory investigations showed leukopenia (total leucocyte count: 3000 cells/cu.mm). Erythrocyte sedimentation rate was 20 mm/1st h. Cerebrospinal fluid (CSF) analysis showed glucose 76 mg/dl, protein 28 mg/dl, and 45 white blood cells with 100% lymphocytes. Video electroencephalogram was normal. Magnetic resonance imaging of brain plain and contrast showed altered signal intensity which was hyperintense on T2-weighted [Figure 1] and fluid-attenuated inversion recovery sequences without any postcontrast enhancement in dorsal pons and midbrain [Figure 2]. CSF tuberculosis polymerase chain reaction (PCR) and Herpes simplex PCR were negative. CSF culture was sterile. CSF adenosine deaminase was 6.9 IU/L. CSF was negative for Listeria, Epstein-Barr virus, Enterovirus, and Cryptococcus. Enzyme-linked immunosorbent assay for human immunodeficiency virus, hepatitis B virus, and hepatitis C virus were negative. Antinuclear antibody, double-stranded DNA, and venereal disease research laboratory test were negative. Serum paraneoplastic neuronal antigen and antibody profile was negative. Mantoux test was negative. The patient was managed with intravenous ceftriaxone 2 g twice daily and intravenous dexamethasone (4 mg thrice daily) for 10 days in suspicion of brainstem encephalitis. She was managed with 0.5 mg once daily clonazepam and 1 mg twice daily trihexyphenidyl for 10 days for blepharospasm. Cervical lymph node fine-needle aspiration cytology was done which showed lymphocytes, sinus histiocytes, endocapillary buds, monocytoid cells, necrosis, karyorrhectic debris, and nodal reticulum suggestive of Kikuchi-Fujimoto disease [Figure 3]. Positron emission tomography (PET) computed tomography brain showed increased focal uptake of tracer in the left frontal lobe, anteriosuperior to anterior cingulate gyrus [Figure 4]. After 10 days of treatment, the patient improved significantly. Cervical lymph nodes resolved. Eye movements were full. Cerebellar signs and blepharospasm disappeared [Videos 3 and 4]. Gait became normal. The patient was followed up at 1-3 months without any residual neurological deficits. Magnetic resonance imaging brain done after 1 month of treatment showed complete resolution of lesions in midbrain and pons [Figure 5].