Miller Fisher Syndrome Presenting After a Second Dose of Pfizer-BioNTech Vaccination in a Patient With Resolved COVID-19: A Case Report

Yoon

Acta Neuro Scandinavica

et al. 2022

Background and Purpose Miller Fisher syndrome (MFS), a variant of Guillain–Barré Syndrome (GBS), could be underestimated in evaluations of its adverse events (AEs) following COVID‐19 vaccination. We aimed to identify and characterize MFS following COVID‐19 vaccination. Materials and Methods Relevant studies reported on during the COVID‐19 pandemic were identified in the MEDLINE, Embase, and other databases. Results Nine cases of MFS following COVID‐19 vaccination from various regions were included. Unlike MFS following COVID‐19 infection, patients with MFS following COVID‐19 vaccination frequently presented with anti‐GQ1b antibody positivity (44%, 4/9). Unlike GBS following COVID‐19 vaccination, only two of nine (22%) cases of MFS following COVID‐19 vaccination had developed after viral‐vector‐related vaccine administration. Conclusions Miller Fisher syndrome following COVID‐19 vaccination seems to have a different pathophysiology from MFS following COVID‐19 infection and GBS following COVID‐19 vaccination. This neurological syndrome with a rare incidence and difficulty in diagnosis should be considered an AE of COVID‐19 vaccination.

“…This resulted in nine articles finally being analyzed for this review. 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 A flow diagram illustrating the full search process is shown in Figure 1 .…”

Section: Resultsmentioning

confidence: 99%

“…We also searched articles that cited any of or were references of the initially included studies. This resulted in nine articles finally being analyzed for this review 8–16 . A flow diagram illustrating the full search process is shown in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

Miller Fisher syndrome following COVID ‐19 vaccines: A scoping review

Yoon

Acta Neuro Scandinavica

et al. 2022

“…Previous reports suggested 80% to 90% positivity of GQ1b antibodies in MFS patients. [ 17 , 21 ] All the reported cases were managed with intravenous immunoglobulins with supportive care and showed remarkable recovery at 4 to 6-week follow-ups indicating a favorable prognosis of the COVID-19 vaccination triggered MFS.…”

Section: Discussionmentioning

confidence: 99%

“…The screening of abstracts revealed 4 cases reporting MFS after COVID-19 vaccination. Michaelson et al, [ 17 ] Abičić et al, [ 18 ] and Nishiguchi et al [ 19 ] reported the neurological spectrum of MFS after Pfizer-BioNTech vaccines. At the same time, Dang and Bryson [ 20 ] described an overlapping syndrome of MFS and GBS after the Oxford-Astrazeneca vaccination.…”

Section: Discussionmentioning

confidence: 99%

Miller Fisher syndrome after COVID-19 vaccination: Case report and review of literature

et al. 2022

Rationale: Miller Fisher syndrome (MFS) is a rare variant of Guillain-Barre syndrome, classically diagnosed based on the clinical triad of ataxia, areflexia, and ophthalmoplegia. MFS is usually preceded by viral infections and febrile illness; however, only a few cases have been reported after vaccinations. Patient concerns: A 53-year-old hypertensive male presented with a 2-day history of progressive ascending paralysis of the lower limbs along with diplopia and ataxia, 8 days after the first dose of the Sinovac–Coronavac coronavirus disease 2019 (COVID-19) vaccination, with no prior history of any predisposing infections or triggers. Diagnoses: Physical examination showed moderate motor and sensory loss with areflexia in the lower limbs bilaterally. Routine blood investigations and radiological investigations were unremarkable. Cerebrospinal fluid analysis showed albuminocytologic dissociation and nerve conduction studies revealed prolonged latencies with reduced conduction velocities. The diagnosis of MFS was established based on the findings of physical examination, cerebrospinal fluid analysis, and nerve conduction studies. Interventions: A management plan was devised based on intravenous immunoglobulins, pregabalin, and physiotherapy. However, due to certain socioeconomic factors, the patient was managed conservatively with regular physiotherapy sessions. Outcomes: Follow-up after 6 weeks showed remarkable improvement, with complete resolution of symptoms 10 weeks after the discharge. Lessons: This case suggests that MFS is a rare adverse effect after COVID-19 vaccination and additional research is required to substantiate a temporal association. Further studies are needed to understand the pathophysiology behind such complications to enhance the safety of COVID-19 vaccinations in the future.

Graefes Arch Clin Exp Ophthalmol

“…In this study, there were six cases of multiple ocular motor cranial nerve palsy, including Miller Fisher syndrome in four patients, Tolosa-Hunt syndrome in one patient, and cavernous involvement of granulomatosis with polyangiitis in one patient. There have been several previous reports of Miller Fisher syndrome after receiving Pfizer-BioNTech COVID-19 vaccine [ 14 , 15 ] or AstraZeneca COVID-19 vaccine [ 16 , 17 ]. All of these cases showed complete or significant improvement after immunoglobulin treatment.…”

Section: Discussionmentioning

confidence: 99%

Ocular motility disorders following coronavirus disease-19 vaccination

Park

Jeon

Choi

et al. 2022

Purpose To describe clinical manifestations and short-term prognosis of ocular motility disorders following coronavirus disease-2019 (COVID-19) vaccination. Methods Ocular motility disorders were diagnosed by clinical assessment, high-resolution magnetic resonance imaging, and laboratory testing. Clinical manifestations, short-term prognosis, and rate of complete recovery were analyzed. Results Sixty-three patients (37 males, 26 females) with a mean age of 61.6 ± 13.3 years (range, 22–81 years) were included in this study. Among 61 applicable patients with sufficient information regarding medical histories, 38 (62.3%) had one or more significant underlying past medical histories including vasculopathic risk factors. The interval between initial symptoms and vaccination was 8.6 ± 8.2 (range, 0–28) days. Forty-two (66.7%), 14 (22.2%), and 7 (11.1%) patients developed symptoms after the first, second, and third vaccinations, respectively. One case of internuclear ophthalmoplegia, 52 cases of cranial nerve palsy, two cases of myasthenia gravis, six cases of orbital diseases (such as myositis, thyroid eye disease, and IgG-related orbital myopathy), and two cases of comitant vertical strabismus with acute onset diplopia were found. Among 42 patients with follow-up data (duration: 62.1 ± 40.3 days), complete improvement, partial improvement, no improvement, and exacerbation were shown in 20, 15, 3, and 4 patients, respectively. Conclusion This study provided various clinical features of ocular motility disorders following COVID-19 vaccination. The majority of cases had a mild clinical course while some cases showed a progressive nature. Close follow-up and further studies are needed to elucidate the underlying mechanisms and long-term prognosis.