Fisher-Bickerstaff syndrome with negative anti-ganglioside antibody test results associated with mycoplasma pneumoniae infection

Abstract

Miller-Fisher syndrome and Bickerstaff brainstem encephalitis are two conditions that have probably a common autoimmune etiology. Anti-ganglioside antibodies are present in most of the patients with these clinical conditions. The symptoms of these disorders variably involve peripheral nervous system or central nervous system. There is an unclassified group of patients who have symptoms of both Miller-Fisher syndrome and Bickerstaff brainstem encephalitis and a new eponymic terminology “Fisher-Bickerstaff syndrome” is suggested for these patients. Mycoplasma Pneumonia as a cause of Fisher-Bickerstaff syndrome has not been reported before. Clinical and radiologic features of a nine-year-old boy with “Fisher-Bickerstaff syndrome” associated with Mycoplasma Pneumonia infection are presented. A nine-year-old boy presented with ptosis, diplopia, drowsiness, areflexia. He had a history of recent upper respiratory tract infection and laboratory evidence of Mycoplasma Pneumonia infection. Brain magnetic resonance imaging revealed hyperintense lesions in the brainstem and electromyography revealed absent H reflex and reduced F wave responses in median nerves. Anti-ganglioside antibodies were negative. The patient dramatically responded to intravenous immunoglobuline treatment. Mycoplasma Pneumonia may cause Fisher-Bickerstaff syndrome without a rise in anti-ganglioside antibodies. Intravenous immunoglubuline treatment seems a good therapeutic option for these cases.