Recurrent Miller Fisher Syndrome: A Case Report

Guillain-Barré syndrome can manifest with progressive paralysis, requiring careful monitoring and treatment with steroids or intravenous (IV) immunoglobin. While this disease can be devastating and require intensive care unit level of care, there are few incidences of relapses.

A 67-year-old man with a past medical history of Miller Fisher syndrome variant of Guillain-Barré syndrome, with complete recovery, presented to the emergency department (ED) with ataxia, ophthalmoplegia, dysphonia, and ambulatory dysfunction. The patient noticed his neurologic symptoms after waking up, and he presented to the ED with physical examination positive for difficulty with upward gaze, mild right lower facial droop, dysmetria with left finger to nose testing, and unsteady gait. A lumbar puncture revealed albuminocytologic dissociation (an elevated cerebrospinal fluid protein count without elevation in white blood cell count) and he was diagnosed with recurrent Miller Fisher syndrome. The patient completed a five-day course of IV immunoglobin with marked improvement of his symptoms. Unfortunately, the patient continued to have ambulatory difficulty, requiring inpatient rehabilitation with residual deficits including ophthalmoplegia and mild dysphonia.

Miller Fisher syndrome is an uncommon variant of Guillain-Barré syndrome with atypical neurologic findings that can lead to respiratory distress; it requires high levels of suspicion and diagnostic evaluation. This disease process can recur in a patient's lifetime, contrary to what has been reported in the literature.