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Case report
Atypical case of Miller-Fisher syndrome presenting with severe dysphagia and weight loss
  1. Kishan Patel1,
  2. Eliezer Nussbaum1,
  3. Jason Sico1,2 and
  4. Naseema Merchant1,3
  1. 1Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
  2. 2Neurology, VA Connecticut Health System, West Haven, Connecticut, USA
  3. 3Internal Medicine, VA Connecticut Health System, West Haven, Connecticut, USA
  1. Correspondence to Dr Naseema Merchant; naseema.merchant{at}yale.edu

Abstract

A 71-year-old man developed dysphagia, bilateral lower extremity muscle weakness and weight loss. He was admitted to the hospital after a failed formal swallow evaluation, nearly 3 weeks after symptom onset. In addition to dysphagia and weakness, physical examination was notable for hypophonia, dysarthria, diplopia, horizontal ophthalmoparesis, ptosis, ataxia and hyporeflexia. Cerebrospinal fluid was notable for albuminocytological dissociation and serum anti-GQ1b antibody titre was elevated (1:200). A diagnosis of Miller-Fisher syndrome (MFS) was made, and the patient was treated with intravenous immunoglobulin (0.4 g/kg/day) for 5 days, which resulted in resolution of symptoms. This is an atypical case of MFS, in that the presenting symptom was progressive dysphagia rather than the ophthalmoplegia and ataxia that are normally seen in MFS. Patients who present with dysphagia should receive a thorough neurological examination, with particular attention to extraocular movements, reflexes and gait stability, to rule out MFS as a potential cause.

  • peripheral nerve disease
  • neurological injury
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Footnotes

  • Contributors KP: initial drafting of manuscript. EN, JS, NM: critical review and editing of manuscript. All authors were involved in caring for the patient.

  • 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.

  • Patient consent for publication Obtained.

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

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