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November 2015

Novel Variant of Miller Fisher Syndrome Occurring With Tumor Necrosis Factor α Antagonist Therapy

Author Affiliations
  • 1John Radcliffe Hospital, Oxford, England
JAMA Neurol. 2015;72(11):1377-1378. doi:10.1001/jamaneurol.2015.2251

Miller Fisher syndrome (MFS) is characterized by the acute onset of external ophthalmoparesis, ataxia, and areflexia,1 and it is highly correlated with the presence of anti-GQ1b antibodies.2 Here we present a case with a limited variant of MFS characterized by mild ophthalmoparesis, pupillary unresponsiveness, lid twitches, and lid hops in the presence of an extremely high anti-GQ1b antibody level differing from the previously described tumor necrosis factor α (TNFα) antagonist–associated MFS cases.3,4

A 43-year-old woman presented to the acute medical team with a 3-day history of worsening diplopia. She initially noticed blurring of distance vision, which then progressed to horizontal diplopia in primary gaze, worsening on gaze to the left-hand side. She also had a mild, nonspecific bitemporal headache. She denied any other neurological symptoms. The patient provided written informed consent to report her case.