A Rare Association Between Herpes Simplex Virus Type 1 and Miller-Fisher Syndrome

Abstract

The etiopathogenesis for Guillain-Barré syndrome (GBS) and Miller-Fisher syndrome (MFS), a variant of GBS, is well-documented in the literature. However, the association between MFS and an underlying herpes simplex virus type 1 (HSV-1) infection is very limited. We present a unique case of a 48-year-old man who developed diplopia, bilateral ptosis, and gait instability following an acute diarrheal illness and recurring cold sores. The patient was diagnosed with MFS precipitated by recurrent HSV-1 infection following a Campylobacter jejuni acute infection. The diagnosis of MFS was supported by a positive anti-GQ1b ganglioside immunoglobulin (Ig)G and abnormal MRI-enhancing lesions of the bilateral cranial nerves III and VI. Intravenous immunoglobulin and acyclovir produced a significant clinical response in the patient within the first 72 hours. Our case highlights the rare association between two pathogens and MFS and the importance of recognizing risk factors, symptomatology, and appropriate workup accompanying an atypical MFS case.

Immunopathology of herpes simplex virus‐associated neuroinflammation: Unveiling the mysteries

“…A positive anti‐GQ1b ganglioside IgG and abnormal MRI‐enhancing lesions affecting the bilateral cranial nerves III and VI facilitated diagnostic confirmation of MFS. Remarkably, intravenous Ig and acyclovir administration induced a substantial clinical improvement within the initial 72 h of treatment 169 . It is important to acknowledge that while this connection between MFS and HSV‐1 exists, it remains a rare and limited association.…”

“…Yet, the connection between HSV and Guillain‐Barré Syndrome (GBS) remains less established. While the precise aetiology of GBS remains elusive, it frequently emerges following infections, including viral ones like the flu or Zika virus 169 …”

“…While the precise aetiology of GBS remains elusive, it frequently emerges following infections, including viral ones like the flu or Zika virus. 169…”

“…Remarkably, intravenous Ig and acyclovir administration induced a substantial clinical improvement within the initial 72 h of treatment. 169 It is important to acknowledge that while this connection between MFS and HSV-1 exists, it remains a rare and limited association.…”