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Updated: Apr 5, 2026
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Published on: March 3, 2014
False-Positive Serum Botulism Bioassay in Miller-Fisher Syndrome
Yuriy Zeylikman1, Vishal Shah, Umang Shah
1*Department of Neurology, Duke University Hospital, Durham, NC; †Department of Neurology, State University of New York/Upstate Medical University, Syracuse, NY; ‡Department of Neurology, Aurora Neuroscience Innovation Institute, St. Luke's Medical Center, Milwaukee, WI; and §Department of Neurology, Cooper Medical School of Rowan University, Camden, NJ.
Abstract:
We describe a patient with acute progressive weakness and areflexia. Both botulism and Miller-Fisher variant of Guillain-Barré syndrome were initial diagnostic considerations, and she was treated with intravenous immunoglobulin and botulinum antitoxin. A mouse bioassay was positive for botulinum toxin A, although her clinical course, electrodiagnostic studies, and cerebrospinal fluid findings supported Miller-Fisher syndrome. This patient's atypical features offer points of discussion regarding the evaluation of patients with acute neuromuscular weakness and emphasize the limitations of the botulism bioassay.
