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CASE REPORT
A rare case of Miller Fisher variant of Guillain-Barré Syndrome (GBS) induced by a checkpoint inhibitor
  1. Caitlin Jane McNeill1,
  2. Janev Fehmi2,
  3. James Gladwin3 and
  4. Christopher Price4
  1. 1 Respiratory, Musgrove Park Hospital, Taunton, UK
  2. 2 Neurology, Southmead Hospital, Bristol, UK
  3. 3 Intensive Care, Royal Free Hospital, London, UK
  4. 4 Neurology, Musgrove Park Hospital, Taunton, UK
  1. Correspondence to Dr James Gladwin, james.gladwin{at}nhs.net

Abstract

With the recent development of novel, more potent cancer treatment, in particular, immune ‘checkpoint inhibitors’, cases of neurological immune-related adverse events are on the rise. Although rare, this includes Guillain-Barré Syndrome (GBS). We present the case of a 68-year-old male who was admitted with sudden onset of worsening neurological symptoms following immunotherapy treatment. These symptoms progressed quickly to respiratory failure requiring intubation and admission to the intensive care unit. He was thoroughly investigated and is believed to have an axonal neuropathy in the form of Miller Fisher Syndrome (MFS) variant of GBS, secondary to immunotherapy treatment. He was initially treated with intravenous immunoglobulin, and later, perhaps more effectively, with high dose steroids which significantly improved his symptoms. This case of checkpoint inhibitor-induced MFS is one of few in the literature and is an important reminder of the potential for new immunotherapeutic agents to cause significant neurotoxic effects. These should be promptly and thoroughly investigated, in particular, as the management of these patients can differ from standard treatments used in these conditions.

  • intensive care
  • neurology
  • neuro itu
  • oncology
  • unwanted effects/adverse reactions
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Footnotes

  • Contributors All authors were involved in the clinical care of the patient in this case report, from his acute presentation to his neurorehabilitation. CJM and CP were involved with initial planning in publishing this as an interesting case. All authors performed literature searching, writing and editing roles.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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