Paralytic ileus as first symptom of Miller Fisher syndrome: A case report
Xiubin Liu1, Xiqi Chen2, Yongkun Zhou3
1Shandong Institute of Literature and Culture, Shandong University of Traditional Chinese Medicine, Jinan City, Shandong Province, People's Republic of China.
Introduction:
Miller Fisher syndrome (MFS), regarded by many scholars as a variant of Guillain Barre syndrome (GBS), accounts for approximately 5% to 10% of GBS cases. The typical clinical manifestations of MFS are extraocular muscle paralysis, ataxia, and tendon reflex loss or disappearance. To date, intestinal obstruction has rarely been reported as the initial symptom.
Patient Concerns:
A 48-year-old woman presenting with abdominal pain and distention was diagnosed with paralytic ileus. There was no significant improvement in symptoms after symptomatic treatment. After that, the patient developed visual rotation, with limited binocular abduction and adduction, and ataxia. Anti-ganglioside testing revealed positive anti-ganglioside antibodies.
Diagnosis:
The patient was diagnosed as MFS.
Interventions:
The early stage is mainly symptomatic treatment of paralytic ileus. After MFS was diagnosed, the patient was given large amounts of immunoglobulin and hormone shock therapy.
Outcomes:
After 1 week, the symptoms of intestinal obstruction and MFS gradually improved. The patient was later discharged automatically for financial reasons. Six months after discharge, the patient was interviewed by telephone, and she had recovered.
Conclusion:
To date, intestinal obstruction has rarely been reported as the initial symptom. In case of inconsistencies between the imaging examinations and clinical symptoms, neuroelectrophysiology and cerebrospinal fluid puncture should be performed, striving for timely detection and treatment.
Insights
Miller Fisher syndrome (MFS), a Guillain Barre syndrome variant, rarely presents with initial intestinal obstruction. Early diagnosis and treatment, including immunoglobulin and hormone therapy, led to recovery in a rare case.
Area of Science:
- Neurology
- Gastroenterology
Background:
- Miller Fisher syndrome (MFS) is a rare variant of Guillain Barre syndrome (GBS), typically presenting with ophthalmoplegia, ataxia, and areflexia.
- Intestinal obstruction is an uncommon initial manifestation of MFS.
Observation:
- A 48-year-old woman initially presented with symptoms of paralytic ileus, including abdominal pain and distention.
- Despite symptomatic treatment for ileus, her condition progressed to include ophthalmoplegia and ataxia.
- Anti-ganglioside antibodies were detected, leading to an MFS diagnosis.
Findings:
- The patient received immunoglobulin and hormone therapy for MFS.
- Symptoms of both intestinal obstruction and MFS resolved within one week of treatment.
- The patient achieved full recovery six months post-discharge.
Implications:
- This case highlights the importance of considering MFS in patients with unexplained neurological symptoms, even when gastrointestinal issues are the primary presentation.
- Neuroelectrophysiology and cerebrospinal fluid analysis are crucial for timely MFS diagnosis when imaging is inconsistent with clinical presentation.
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