Miller–Fisher syndrome – A diagnostic conundrum – A case report and review of literature

Abstract

Miller–Fisher syndrome is a rare subvariant of Guillian–Barre syndrome, presenting with ophthalmoplegia, ataxia, and areflexia. We present a 37-year-old male with progressive bilateral external ophthalmoplegia with moderate left-eye ptosis. He developed myalgia, ataxia, and absent deep tendon reflexes. He was initially treated with thiamine infusion and pyridostigmine because of possible Wernicke’s encephalopathy or myasthenia with no improvement. Lumbar puncture revealed acellular smear with high protein. He was switched to IV immunoglobulin therapy proceeding which he showed improvement. We present this case due to its unusual nature and complex diagnostic conundrum.