Pediatric Miller Fisher Syndrome Complicating an Epstein–Barr Virus Infection

In this article we review complications to the peripheral nervous system that occur as a consequence of viral infections, with a special focus on complications of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). We discuss neuromuscular complications in three broad categories; the direct consequences of viral infection, autoimmune neuromuscular disorders provoked by viral infections, and chronic neurodegenerative conditions which have been associated with viral infections. We also include discussion of neuromuscular disorders that are treated by immunomodulatory therapies, and how this affects patient susceptibility in the current context of the coronavirus disease 2019 (COVID-19) pandemic. COVID-19 is associated with direct consequences to the peripheral nervous system via presumed direct viral injury (dysgeusia/anosmia, myalgias/rhabdomyolysis, and potentially mononeuritis multiplex) and autoimmunity (Guillain Barré syndrome and variants). It has important implications for people receiving immunomodulatory therapies who may be at greater risk of severe outcomes from COVID-19. Thus far, chronic post-COVID syndromes (a.k.a: long COVID) also include possible involvement of the neuromuscular system. Whether we may observe neuromuscular degenerative conditions in the longer term will be an important question to monitor in future studies.

show abstract

“…Individual case reports of MFS patients with anti-ganglioside antibodies (GQ1b) post EBV infection (34).…”

Section: Miller-fisher Syndrome (Mfs)mentioning

confidence: 99%

“…There may also be a connection between EBV infection and autoimmune neuromuscular disorders. Case reports connect EBV to GBS (201,202) and variants such as Miller-Fisher syndrome (34,203) and acute motor axonal neuropathy [AMAN (204)]. There is also a reported case of GBS with EBV and SARS-CoV-2 coinfection (205).…”

Section: Epstein-barr Virus (Ebv Hhv-4)mentioning

confidence: 99%

Neuromuscular Complications of SARS-CoV-2 and Other Viral Infections

et al. 2022

View full text Add to dashboard Cite

show abstract

“…The pathophysiology of the variants of GBS (MFS and BBE) is not well understood [4][5][6] . They can be induced by different triggers/pathogens, including idiopathic, viral and bacterial causes, drugs (heroin, suramin, streptokinase, isotretinoin, tumour necrosis factor alpha inhibitors), autoimmune diseases (lupus, sarcoidosis), surgery, bone marrow transplantation, and even vaccination [6][7][8] . Rarely, MFS has occurred after COVID-19, Campylobacter jejuni, Zika virus, herpesvirus 8, Norovirus, human immunodeficiency virus, and Epstein-Barr virus infection [6,7,9,10] .…”

Section: Discussionmentioning

confidence: 99%

Japanese encephalitis virus triggered overlapping Miller Fischer syndrome with Bickerstaff encephalitis in a young Filipino crruise line worker

Hussain

Garcia

Angly

et al. 2023

European Journal of Case Reports in Internal Medicine

View full text Add to dashboard Cite

Japanese encephalitis virus is an RNA flavivirus and one of the rare pathogens that can cause encephalitis. The main vector is the Culex tritaeniorhynchus mosquito. The virus is very close in pathophysiology and structure to the West Nile and St. Louis encephalitis viruses. It is endemic in Asia and Western Pacific areas, mostly during the summer; only a few cases have been reported outside those regions. We present the case of a young Filipino cruise line male worker with signs and symptoms of Japanese encephalitis concomitantly with Miller Fisher syndrome and Bickerstaff brainstem encephalitis. The patient developed obtundation, ataxia, areflexia, flaccid paralysis, and ophthalmoplegia, which were preceded by a few days of constitutional symptoms (fever, malaise, fatigue and anorexia). Physical examination showed various stages of erythema nodosum on the lower extremities. Analysis of cerebrospinal fluid was positive for anti-GQ1b, West Nile IgG and Japanese encephalitis IgM. Despite the neurological complications and bradyarrhythmia occurring during hospitalization, the patient recovered completely under our regimen.

show abstract

“…Anti-GQ1b antibody has been reported to be present in 81% of patients with MFS. 31 Despite gangliosides being a possible target for IgG antibodies for patients exposed to viral infections, 2 30 32 the presence of antiganglioside antibodies in patients with MFS associated with SARS-CoV-2 infection seems to be uncommon. In MFS patients who are positive for anti-GQ1b antibodies, there is a possibility of cross-reaction with other gangliosides such as GT1a, GD1b, and GD3.…”

Section: Discussionmentioning

confidence: 99%

Miller Fisher Syndrome in Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Systematic Review

et al. 2021

View full text Add to dashboard Cite

Background and Purpose Miller Fisher syndrome (MFS) is a subtype of Guillain-Barré syndrome characterized by the triad of ophthalmoparesis, areflexia, and ataxia. Although cases of MFS have been associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, no studies have synthesized the clinical characteristics of patients with this condition. Methods In this rapid systematic review, we searched the PubMed database to identify studies on MFS associated with SARS-CoV-2 infection. Results This review identified 11 cases, of whom 3 were hospitalized with motor and/or sensory polyneuropathy as the first sign of SARS-CoV-2 infection. SARS-CoV-2 RNA was not detected in analyses of cerebrospinal fluid, suggesting a mechanism of immune-mediated injury rather than direct viral neurotropism. However, antiganglioside antibodies were found in only two of the nine patients tested. It is possible that target antigens other than gangliosides are involved in MFS associated with SARS-CoV-2 infection. Conclusions The present patients exhibited clinical improvement after being treated with intravenous immunoglobulin. Although rare, patients with SARS-CoV-2 infection may present neurological symptoms suggestive of MFS. Early recognition of the MFS clinical triad is essential for the timely initiation of treatment.

show abstract

Pediatric Miller Fisher Syndrome Complicating an Epstein–Barr Virus Infection

Cited by 9 publications

References 10 publications

Neuromuscular Complications of SARS-CoV-2 and Other Viral Infections

Neuromuscular Complications of SARS-CoV-2 and Other Viral Infections

Japanese encephalitis virus triggered overlapping Miller Fischer syndrome with Bickerstaff encephalitis in a young Filipino crruise line worker

Miller Fisher Syndrome in Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Systematic Review

Contact Info

Product

Resources

About