A unique case of Miller Fisher-Guillain-Barr\xe9 overlap syndrome in a liver transplant recipient

Claudia Ramirez-Sanchez,Angela Meier,Jamie Nicole Labuzetta,Diana J Hylton,Mahnaz Taremi,Rehan Syed

doi:10.1007/s13365-021-01015-6

Abstract

Guillain-Barré syndrome (GBS) is an ascending demyelinating polyneuropathy often associated with recent infection. Miller Fisher syndrome represents a variant with predominant facial and cranial nerve involvement, although Miller Fisher and Guillain-Barré overlap syndromes can occur. Guillain-Barré spectrum syndromes have been thought to be rare among solid organ transplant recipients. We describe an immunocompromised patient with a liver transplant who presented with ophthalmoplegia and bulbar deficits. His symptoms rapidly progressed to a state of descending paralysis involving the diaphragm; he then developed acute respiratory failure and eventually developed quadriparesis. Electromyography and a nerve conduction study demonstrated a severe sensorimotor axonal polyneuropathy consistent with Miller Fisher variant Guillain-Barré syndrome. Despite several negative nasopharyngeal swabs for COVID-19 polymerase chain reaction, a serology for SARS-CoV-2 IgG was positive. He was diagnosed with Miller Fisher-Guillain-Barré overlap syndrome with rapid recovery following treatment with plasma exchange. Although Guillain-Barré is a rare complication in solid organ transplant recipients, this case highlights the importance of rapid diagnosis and treatment of neurologic complications in transplant patients. Furthermore, it demonstrates a possible case of neurological complications from COVID-19 infection.

Highlights

Guillain-Barré Syndrome (GBS) has been thought to be less common among solid organ transplant recipients (El-Sabrout et al 2001)
We describe an immunocompromised patient after liver transplantation who presented with symptoms of acute progressive descending weakness initially concerning for botulism, but consistent with variant GBS
The diagnosis of Miller Fisher syndrome (MFS)-GBS overlap was made based on clinical features including acute onset of ophthalmoplegia and areflexia followed by subsequent progressive descending flaccid weakness, laboratory findings such as Cerebrospinal fluid (CSF) albuminocytologic dissociation, and results from EMG/Nerve conduction studies (NCS)

Summary

Introduction

Guillain-Barré Syndrome (GBS) has been thought to be less common among solid organ transplant recipients (El-Sabrout et al 2001). We describe an immunocompromised patient after liver transplantation who presented with symptoms of acute progressive descending weakness initially concerning for botulism, but consistent with variant GBS.

Results

Conclusion