A 52-year-old previously healthy man was hospitalized with a 6-day history of progressive gait instability rendering him unable to walk. He reported no respiratory symptoms or fever. He was a smoker (5–10 pack-years) and consumed an undisclosed amount of alcohol over weekends for some years. At presentation, he was tachypneic (20 bpm) and pyrexial (37.7°C) but alert and oriented. He exhibited cerebellar signs, including multidirectional gaze-evoked nystagmus, dysarthria, and truncal and appendicular ataxia. His examination was otherwise normal.