Navneet Kaur, MD
Fellow
Florida Atlantic University Charles E Schmidt College of Medicine
Boca Raton, Florida, United States
Disclosure information not submitted.
Meagan Mayo, DO,
Resident
Florida Atlantic University, Charles E Schmidt College of Medicine
Boca Raton, Florida
Disclosure information not submitted.
Michael Torres
Medical Student
Florida Atlantic University Charles E Schmidt College of Medicine, United States
Disclosure information not submitted.
Title: Miller-Fisher Syndrome and COVID Vaccination
Introduction: Guillain Barre Syndrome (GBS) is an acute, autoimmune peripheral neuropathy resulting in paralysis. The pathogenesis involves molecular mimicry between peripheral nerves and microbial/viral antigens that trigger complement fixation and macrophage attraction to myelin glycolipids. Miller-Fisher syndrome (MFS) is a rare variant, estimated to affect 1-2 in 1,000,000 cases of GBS. It is linked to specific antibodies against GQ1b (a ganglioside component of nerves). Unlike GBS, MFS begins with the optic muscles and progresses downward. The classic triad involves acute ophthalmoplegia, areflexia, and ataxia. We present a case of MFS after COVID-19 vaccination.
Description: A 32-year-old male with no significant medical history presents with progressive facial motor and sensory dysfunction. He received the Johnson & Johnson COVID-19 vaccination 18 days prior. For three days, he had blurry vision, eye pain, and dysarthria. Then, over 24 hours, he became unable to smile and drink/eat due to facial weakness. In the ED, the patient was afebrile and hemodynamically stable. Lab work was unremarkable. Physical exam demonstrated significant facial diplegia including inability to fully close the eyes, raise the eyebrows, and smile. MRI and MRA head and neck did not reveal any abnormalities. The patient underwent lumbar puncture which revealed an albuminocytologic dissociation with negative cultures and antibodies against GQ1B. The patient was monitored in the ICU and improved with IVIg.
Discussion: The link between COVID-19 and GBS remains uncertain. One large observational study, by Keddie et al., found no association between COVID-19 infection and GBS across the UK. However, a smaller study by Filosto et al. found a significant increase in incidence among the Italian population. With COVID-19 vaccination, the data is even less clear. Two patients in the Johnson and Johnson COVID-19 vaccine trial developed GBS, however one of these was in the placebo group. For comparison, with influenza vaccination, there are1-3 additional cases of GBS per million annually. At this time, clinicians should avoid drawing associations between COVID-19 and GBS, but should remain vigilant in their practice, especially in recently immunized patients. The benefits of vaccination continue to far outweigh the small risk of GBS.