Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2024; 12(31): 6500-6505
Published online Nov 6, 2024. doi: 10.12998/wjcc.v12.i31.6500
Miller fisher syndrome with positive anti-GQ1b/GT1a antibodies associated with COVID-19 infection: A case report
Cheng-Qun Wei, Xuan Yu, Yuan-Yuan Wu, Qing-Jie Zhao
Cheng-Qun Wei, Xuan Yu, Yuan-Yuan Wu, Department of Neurology, Huai’an Hospital, Huai’an Cancer Hospital, Huai’an 223001, Jiangsu Province, China
Qing-Jie Zhao, Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin 150081, Heilongjiang Province, China
Co-first authors: Cheng-Qun Wei and Xuan Yu.
Author contributions: Wei CQ, Yu X and Wu YY are responsible for the manuscript design, neurological examination, collection and review of the participants’ data, and final revision before submission for publication; Zhao QJ are responsible for editing and final revision.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qing-Jie Zhao, MD, Chief Doctor, Department of Neurology, The First Affiliated Hospital of Harbin Medical University, No. 199 Dazhi Street, Nangang District, Harbin 150081, Heilongjiang Province, China. zhaoqingjie0509@126.com
Received: May 9, 2024
Revised: August 9, 2024
Accepted: August 16, 2024
Published online: November 6, 2024
Processing time: 124 Days and 17.9 Hours
Abstract
BACKGROUND

Miller fisher syndrome (MFS) is a variant of Guillain-Barré syndrome, an acute immune-mediated peripheral neuropathy that is often secondary to viral infections. Anti-ganglioside antibodies play crucial roles in the development of MFS. The positive rate of ganglioside antibodies is exceptionally high in MFS patients, particularly for anti-GQ1b antibodies. However, the presence of other ganglioside antibodies does not exclude MFS.

CASE SUMMARY

We present a 56-year-old female patient who suddenly developed right blepharoptosis and progressively worsening vision in both eyes. There were flu symptoms prior to onset, and a coronavirus disease 2019 test was positive. On physical examination, the patient exhibited bilateral extraocular muscle paralysis, weakened reflexes in both limbs, and impaired coordination. The cerebrospinal fluid examination results showed no obvious abnormalities. Bilateral peroneal nerve F-waves were not extracted. Serum anti-GD1b IgG and anti-GT1a IgG antibodies were positive. The patient received intravenous methylprednisolone (1000 mg/day), with the dosage gradually decreased. Additionally, intravenous high-dose immunoglobulin treatment was administered for 5 days (0.4 g/kg/day) from day 2 to day 6 of hospitalization. The patient’s symptoms improved after treatment with immunoglobulins and hormones.

CONCLUSION

Positive ganglioside antibodies may be used as supporting evidence for the diagnosis; however, the diagnosis of MFS is more reliant on clinical symptoms.

Keywords: Miller fisher syndrome; Guillain-Barre syndrome; COVID-19; Anti-GQ1b antibody; Anti-GT1a antibody; Case report

Core Tip: This case study reports a unique presentation of Miller fisher syndrome with positive anti-GQ1b and anti-GT1a antibodies alongside multiple autoimmune markers. While ganglioside antibodies offer supportive evidence, Miller fisher syndrome diagnosis primarily relies on clinical manifestations, emphasizing the importance of comprehensive clinical assessment in diagnosing this immune-mediated neuropathy.