Ophthalmoplegia Due to Miller Fisher Syndrome in a Patient With Myasthenia Gravis.

Abstract:

:Here, we describe a 79-year-old man, admitted to our unit for worsening diplopia and fatigue, started a few weeks after an episode of bronchitis and flu vaccination. Past medical history includes myasthenia gravis (MG), well-controlled by Pyridostigmine, Azathioprine, and Prednisone. During the first days, the patient developed progressive ocular movement abnormalities up to complete external ophthalmoplegia, severe limb and gait ataxia, and mild dysarthria. Deep tendon reflexes were absent in lower limbs. Since not all the symptoms were explainable with the previous diagnosis of myasthenia gravis, other etiologies were investigated. Brain MRI and cerebrospinal fluid analysis were normal. Electromyography showed a pattern of predominantly sensory multiple radiculoneuritis. Suspecting Miller Fisher syndrome (MFS), the patient was treated with plasmapheresis with subsequent clinical improvement. Antibodies against GQ1b turned out to be positive. MFS is an immune-mediated neuropathy presenting with ophthalmoplegia, ataxia, and areflexia. Even if only a few cases of MFS overlapping with MG have been described so far, the coexistence of two different autoimmune disorders can occur. It is always important to evaluate possible differential diagnosis even in case of known compatible diseases, especially when some clinical features seem atypical.

journal_name

Front Neurol

journal_title

Frontiers in neurology

authors

Brusa R,Faravelli I,Gagliardi D,Magri F,Cogiamanian F,Saccomanno D,Cinnante C,Mauri E,Abati E,Bresolin N,Corti S,Comi GP

doi

10.3389/fneur.2019.00823

subject

Has Abstract

pub_date

2019-08-13 00:00:00

pages

823

issn

1664-2295

journal_volume

10

pub_type

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