Miller Fisher Syndrome mimicking botulism: a case report of Guillain-Barré/Miller Fisher overlap syndrome caused by COVID-19 and EBV coinfection

Eileen Guzmán-Rojas, Pulmonary & Critical Care Medicine Fellowship, VA Caribbean Healthcare System, San Juan, Puerto Rico, Estados Unidos
Mark Vergara-Gomez, Pulmonary & Critical Care Medicine Fellowship Attending Physician, VA Caribbean Healthcare System, San Juan, Puerto Rico, Estados Unidos
Gerald L. Marín-García, Pulmonary & Critical Care Medicine Fellowship, VA Caribbean Healthcare System, San Juan, Puerto Rico, Estados Unidos
William Rodríguez-Cintrón, Pulmonary & Critical Care Medicine Fellowship Chief. VA Caribbean Healthcare System, San Juan, Puerto Rico, Estados Unidos

Miller-Fisher syndrome (MFS) is a rare variant of Guillain Barre Syndrome (GBS), most commonly associated with the involvement of the lower cranial and facial nerves without weakness of the respiratory system and limbs. Nevertheless, bulbar involvement is uncommon but can lead to extensive workup to rule out stroke, botulism, myasthenia gravis (MG), and other neuromuscular disorders. Despite unknown incidence in literature, there are some cases in which MFS coexists with other features of GBS have been reported, such as limb weakness, paresthesia, and facial palsy, are considered MFS - GBS overlap syndromes. Therefore, we present a rare case of GBS/MFS overlap syndrome describing the importance of prompt evaluation, diagnosis, and management by team-based interprofessional care to improve outcomes in these patients.

Keywords: Miller-Fisher syndrome. Guillain-Barré syndrome. MFS-GBS overlap syndromes. Weakness in the extremities. Facial palsy.