Overlap of Miller-Fisher Syndrome and Pharyngeal-Cervical-Brachial Variant Secondary to COVID-19 in Recurrent Guillain-Barré Syndrome: A Case Report

Abstract

Miller-Fisher syndrome (MFS) is characterized by the three major components of ophthalmoplegia, ataxia, and areflexia. The occurrence of MFS is relatively uncommon because of its monophasic nature, while recurrent Guillain-Barré syndrome (GBS) is a well-known condition. The pharyngeal-cervical-brachial (PCB) variant is a scarce variant of GBS (3%), which presents with muscle weakness initially involving the neck, oropharynx, and upper extremities. The patient's first symptoms were tingling in all the limbs, followed by ophthalmoplegia, ataxia, and areflexia. Additional bilateral ptosis and flu-like illness were also present. The patient subsequently developed a choking sensation with pharyngeal muscle weakness, which necessitated ventilatory support. Cerebrospinal fluid (CSF) protein levels and anti-ganglioside antibodies were both negative. During the patient's hospital admission, he received intravenous immunoglobulins (IVIGs), indicating that immunomodulating medications may be useful in managing MFS. This constellation of symptoms was induced by SARS-CoV-2 infection, confirmed by a positive polymerase chain reaction (PCR) test. This case underscores the critical role of comprehensive history-taking and physical examination in diagnosing such cases, as COVID-19-induced GBS variants have frequently demonstrated repeatedly negative antibody results. We present an unusual case of a 63-year-old male with MFS induced by COVID-19, with overlapping symptoms of the PCB variant of GBS on a background of previously recurrent GBS.

Keywords: covid 19; gillian barre syndrome; miller fisher variant; miller-fisher syndrome; pharyngeal-cervical-brachial (pcb) variant.