Abstract
In this case report, we describe a patient who was first diagnosed with Miller Fisher syndrome (MFS) combined with myasthenia gravis (MG). A 58-year-old male patient presented with acute dysarthria with dizziness, ophthalmoplegia, absence of deep tendon reflexes in the extremities, and ataxia. Lumbar puncture 1 week after onset showed albuminocytologic dissociation and serum antibodies against GQ1b and GT1a turned out to be positive. Ultimately, the patient was diagnosed with MFS, which is a rare variant of Guillain-Barre syndrome. Because the clinical manifestations of the patient could not exclude MG, electromyography, and serum muscle weakness antibody profile were performed. The results showed positive for axillary nerve repetitive electrical stimulation and antibodies against acetylcholine receptor (AChR) and titin were detected, so the patient was diagnosed with MG at the same time. Even though only five cases of overlapping MFS and MG so far have been described, two different autoimmune diseases may coexist. When one disease presents with uncommon symptoms, careful identification of the presence or absence of other comorbid diseases should be required.
Highlights
Miller Fisher syndrome (MFS) is a rare variant of Guillain-Barre syndrome (GBS), an acute, immune-mediated, monophasic disease that usually presents as ocular muscle paralysis, dysreflexia, and ataxia
Together with the five previously published cases of co-morbid MFS and myasthenia gravis (MG), this is the second case in which both diseases were diagnosed simultaneously for the first time, with the first case being published in 2016 [4]
Anti-GQ1b antibodies can cross-react with anti-GT1a antibodies in MFS
Summary
Miller Fisher syndrome (MFS) is a rare variant of Guillain-Barre syndrome (GBS), an acute, immune-mediated, monophasic disease that usually presents as ocular muscle paralysis, dysreflexia, and ataxia. The worldwide incidence of GBS is estimated to be 1–2 per 100,000 people. The worldwide incidence is estimated to be between 0.3 per 100,000 people and 2.8 per 100,000 people [2]. The incidences of both diseases are low, so the chance of overlap between the two diseases is very low, with only 5 cases reported worldwide [3,4,5,6,7]
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