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Miller Fisher syndrome mimicking stroke in immunosuppressed patient with rheumatoid arthritis responding to plasma
1Department of Neurology, Heidelberg Repatriation Hospital, Melbourne, VIC Australia.
Abstract:
A patient with rheumatoid arthritis on immunosuppressive therapy was admitted to hospital with the sudden onset of diplopia and ataxia. Because of the history, a stroke was thought most likely. However, as he progressed a diagnosis of the Miller Fisher syndrome was established. He responded to plasma exchange. This presentation is highly unusual and has not previously been described. In addition, the possibility of immune dysregulation setting the stage for the development of this syndrome is discussed. The role of plasma exchange for this condition is also reviewed.
Insights
A rare case of Miller Fisher syndrome, a neurological disorder, occurred in a rheumatoid arthritis patient on immunosuppressants. The patient recovered after plasma exchange treatment, highlighting an unusual presentation and treatment response.
Area of Science:
- Neurology
- Immunology
- Rheumatology
Background:
- Rheumatoid arthritis (RA) patients on immunosuppressive therapy are susceptible to various complications.
- Neurological complications can mimic other conditions, posing diagnostic challenges.
Observation:
- A patient with rheumatoid arthritis presented with sudden onset diplopia and ataxia.
- Initial symptoms suggested a stroke due to the patient's medical history.
Findings:
- The patient was diagnosed with Miller Fisher syndrome (MFS), a rare variant of Guillain-Barré syndrome.
- MFS diagnosis was established as the patient's condition progressed.
- The patient showed significant improvement following plasma exchange therapy.
Implications:
- This case highlights an unusual presentation of Miller Fisher syndrome in an RA patient.
- The findings suggest a potential role for immune dysregulation in MFS development.
- Plasma exchange is an effective treatment for this rare neurological presentation.