J Korean Ophthalmol Soc.  2016 Mar;57(3):528-531. 10.3341/jkos.2016.57.3.528.

A Case of Miller Fisher Syndrome in a Pediatric Patient with Positive Anti-GQ1b IgG

• Kim EJ
• Ha SG
• Kim SH

• KMID: 2213258
• DOI: http://doi.org/10.3341/jkos.2016.57.3.528

Abstract

PURPOSE
To report a case of Miller Fisher syndrome in a pediatric patient with gastroenteritis associated with seroconversion of Campylobacter jejuni titer during the development of neurological symptoms and positive anti-GQ1b IgG.
CASE SUMMARY
An 8-year-old male patient visited our clinic with bilateral ophthalmoplegia, diplopia, and ptosis of the right upper lid. He had experienced gastroenteritis one week previous, and antibodies to Campylobacter jejuni were detected in his plasma. Ophthalmic examination revealed a corrected visual acuity of 20/20 in both eyes. Ocular motor examination revealed limitations in all positions of gaze. Neurologic examination demonstrated areflexia and ataxia. The serologic anti-GQ1b IgG test was positive. Intravenous immunoglobulin and steroid pulse therapy were started. Extraocular movement, ptosis, and ataxia gradually improved after one month of treatment.
CONCLUSIONS
We confirmed a case of Miller Fisher syndrome in a pediatric patient with bilateral ophthalmoplegia, ptosis, and a positive anti-GQ1b antibody test.

Keyword

Anti-GQ1b IgG antibody; Miller Fisher syndrome; Pediatric patient

MeSH Terms

Antibodies
Ataxia
Campylobacter jejuni
Child
Diplopia
Gastroenteritis
Humans
Immunoglobulin G*
Immunoglobulins
Male
Miller Fisher Syndrome*
Neurologic Examination
Ophthalmoplegia
Plasma
Visual Acuity
Antibodies
Immunoglobulin G
Immunoglobulins

Figure

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  Figure 1. Photographs of the patient at initial visit. Photographs of nine cardinal direction of gaze showed limitation in all positions of gaze.

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  Figure 2. Photographs of the patient 10 days after treatment. Ocular motor examination revealed limitation of depression was improved than the other gaze limitation.

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  Figure 3. Photographs of the patient 1 month after treatment. Ocular motor examination revealed limitation of all gaze was im proved.

Reference

References

1. Fisher M. An unusual variant of acute idiopathic polyneuritis (syndrome of ophthalmoplegia, ataxia and areflexia). N Engl J Med. 1956; 255:57–65.

2. Berlit P, Rakicky J. The Miller Fisher syndrome. Review of the literature. J Clin Neuroophthalmol. 1992; 12:57–63.

3. Eggenberger ER, Coker S, Menezes M. Pediatric Miller Fisher syndrome requiring intubation: a case report. Clin Pediatr (Phila). 1993; 32:372–5.

4. Ajena D, Ferrari S, Romito S, et al. A pediatric case of Miller Fisher syndrome with central involvement. Neurol Sci. 2013; 34:1689–90.

5. Mezer E, Buncic JR. Childhood Miller Fisher syndrome: case report and review of the literature. Can J Ophthalmol. 2002; 37:352–7. quiz 358.

6. Chung SD, Ko KO, Rhee KS, Chung YH. A case of miller fisher syndrome. J Korean Child Neurol Soc. 1993; 1:158–64.

7. Chueh H, Kwon EY, Shin HY, Hwang KG. A case of child with Miller Fisher syndrome diagnosed by anti-GQ1b antibody from mycoplasma pneumoniae. J Korean Child Neurol Soc. 2007; 15:211–5.

8. Ju M, Lee KH, Kim SY. Two cases of Miller Fisher syndrome without ataxia. J Korean Child Neurol Soc. 2007; 15:205–10.

9. Koga M, Gilbert M, Li J, et al. Antecedent infections in Fisher syndrome: a common pathogenesis of molecular mimicry. Neurology. 2005; 64:1605–11.

10. Roberts M, Willison H, Vincent A, Newsom-Davis J. Serum factor in Miller-Fisher variant of Guillain-Barré syndrome and neurotransmitter release. Lancet. 1994; 343:454–5.

11. Nishimoto Y, Odaka M, Hirata K, Yuki N. Usefulness of anti-GQ1b IgG antibody testing in Fisher syndrome compared with cerebrospinal fluid examination. J Neuroimmunol. 2004; 148:200–5.

12. Ohtsuka K, Nakamura Y, Tagawa Y, Yuki N. Immunoadsorption therapy for Fisher syndrome associated with IgG anti-GQ1b antibody. Am J Ophthalmol. 1998; 125:403–6.

13. Zifko U, Drlicek M, Senautka G, Grisold W. High dose immunoglobulin therapy is effective in the Miller Fisher syndrome. J Neurol. 1994; 241:178–9.

14. Yeh JH, Chen WH, Chen JR, Chiu HC. Miller Fisher syndrome with central involvement: successful treatment with plasmapheresis. Ther Apher. 1999; 3:69–71.

15. Overell JR, Hsieh ST, Odaka M, et al. Treatment for Fisher syndrome, Bickerstaff's brainstem encephalitis and related disorders. Cochrane Database Syst Rev. 2007; (1):CD004761.