Miller Fisher syndrome after COVID-19 vaccination: a case report

Case presentation: 17-year-old male patient, previously healthy. Twoweeks prior to symptoms reports immunization against COVID-19. Admitted presenting asthenia, limb paresthesia, ophthalmoparesis, diplopia, ataxia, decreased muscle strength with ascending progression, urinary and fecal incontinence, peripheral facial paralysis, dysphagia, dysphonia and mental confusion. The neurological examination showed global areflexia, grade IV strength in upper limbs and grade III strength in lower limbs. During hospitalization evolved with respiratory failure and need for orotracheal intubation. Cranial MRI showed neuritis of the facial nerves and spinal MRI showed enhancement of the roots of the cauda equina. CSF with cytological protein dissociation, suggestive of Guillain-Barré Syndrome Variant of Miller Fisher. He was treated with intravenous human immunoglobulin 400 mg/kg/day for 7 days with partial improvement of symptoms. He needed a mature tracheostomy due to difficulty in extubation. After 23 days, he was discharged to a rehabilitation hospital.

Discussion: Miller Fisher syndrome (MFS) is a multifocal neuropathy that presents with ataxia, ophthalmoplegia and areflexia. Cranial nerves may be involved, especially the facial nerve. It is a rare variant of Guillain-Barré Syndrome. Associated with viral infection of the gastrointestinal or respiratory tract, or Campybacter infection. Few cases are reported associated with COVID vaccination, and pediatric cases are rare. After COVID-19 peripheral nerve immunity response, means of molecular mimids against ganglia. In SMF, there is formation of anti-GQ1b (Anti-GQ1b), but due to its high cost, a protein-cytological dissociation in the CSF should be sought. The time interval between vaccination and the onset of MFS was 15 days similar to previous case reports in the adult population. The prognosis is generally favorable as it is a self-limiting disease that responds to immunoglobulin treatment.

Final comments: Recent vaccination and absence of any other signs or laboratory findings suggest that the vaccine is the trigger. Additional research is needed to establish an association between SMF and COVID-19 vaccination. The risk is low and the benefits of vaccination outweigh any potential risks or side effects.

 

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Artikel online veröffentlicht:
18. September 2023