Miller Fisher syndrome: a case report and review of the literature

BACKGROUND: Miller Fisher syndrome is a rare and challenging condition to diagnose. This article presents the case of a patient with severe and rapidly progressing symptoms who was initially misdiagnosed with cerebral infarction. Following methylprednisolone treatment, the patient's prognosis improved significantly. CASE PRESENTATION: The patient was a 63-year-old east Asian female farmer who was admitted with complaints of "dizziness, double vision, and unsteady gait for 14 hours." She subsequently developed respiratory distress, requiring ventilatory support and experienced a drop in blood pressure, which was managed with vasopressors. Initially misdiagnosed as having cerebral infarction, she received treatment with 3-butylphthalide, aspirin, and atorvastatin, but her symptoms did not improve. Serum tests were positive for anti-GQ1b and anti-GT1a IgG antibodies. This, combined with her history of a preceding infection and the presence of the clinical triad (ophthalmoplegia evidenced by diplopia and nystagmus, ataxia evidenced by unsteady gait and incoordination, and areflexia/hyporeflexia evidenced by absent pharyngeal reflex and diminished tendon reflexes), led to a final diagnosis of Miller Fisher syndrome (anti-GQ1b antibody-positive). Following treatment with methylprednisolone, her symptoms improved significantly. CONCLUSION: This report not only shares valuable clinical management experiences related to Miller Fisher syndrome, but also aims to enhance readers' understanding of the condition. Furthermore, this case is noteworthy as it documents the emergence of life-threatening symptoms such as respiratory distress and hypotension, which are atypical for Miller Fisher syndrome and highlight the potential for severe disease progression.