Overlapping Miller Fisher Syndrome Following Primary Varicella Zoster Infection: A Case Report

¹National Hospital-Kandy, Sri Lanka

²University of Peradeniya, Sri Lanka

*Corresponding author: Sinnarajah Krishnapradeep, Department of Paediatrics, Faculty of Medicine, University of Peradeniya, Sri Lanka, Phone Number: +94776507576; Email: [email protected].

Received Date: January 28, 2024

Published Date: February 21, 2024

Citation: Sumanasena AHCM, et al. (2024). Overlapping Miller Fisher Syndrome Following Primary Varicella Zoster Infection: A Case Report. Mathews J Pediatr. 9(1):34.

Copyrights: Sumanasena AHCM, et al. © (2024).

ABSTRACT

Miller-Fisher syndrome (MFS) is a variant of Guillain-Barre syndrome (GBS). The typical presentation of MFS includes a combination of ataxia, areflexia, and ophthalmoplegia, usually without limb weakness. However, some patients with MFS may exhibit an incomplete set of symptoms or display features that overlap with those of typical GBS. We describe the case of a 9-year-old boy who presented with unsteady gait and bilateral lower limb weakness, along with a recent history of resolved Varicella-Zoster Virus (VZV) infection. Despite lacking fever, speech or swallowing difficulties, or abnormalities in sphincter control, he showed signs of ataxia, areflexia, and lower limb weakness on examination, without ophthalmoplegia. Further investigations revealed elevated protein levels and no cells in the cerebrospinal fluid (CSF), as well as evidence of acute focal and segmental inflammatory demyelinating polyneuropathy on nerve conduction studies. The child was diagnosed with an overlapped variant of MFS/GBS following primary VZV infection and achieved complete recovery with intravenous immunoglobulin (IVIg) treatment and other supportive measures. This case illustrates a subtype of MFS known as MFS/GBS overlapped syndrome, wherein the patient displayed MFS features alongside limb weakness. The presence of incomplete MFS symptoms and overlapping features with GBS posed a diagnostic challenge, underscoring the importance of considering rare variants when patients exhibit atypical presentations.

Keywords: Guillain-Barre Syndrome, Miller-Fisher Syndrome, Varicella Zoster, Acute Flaccid Paralysis.