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Novel Variant of Miller Fisher Syndrome Occurring With Tumor Necrosis Factor α Antagonist Therapy

Gokulan Ratnarajan, BSc, MBBS, FRCOphth1; Alexander Thompson, BMBCh(Oxon), MRCP(UK)1; Caroline Dodridge, DBO(D)1; Allyson Parry, BSc(Hons), MBChB(Hons), DPhil(Oxon), FRCP1; John Elston, MBBS, BSc, MD, FRCS, FRCOphth1
[+] Author Affiliations
1John Radcliffe Hospital, Oxford, England
JAMA Neurol. 2015;72(11):1377-1378. doi:10.1001/jamaneurol.2015.2251.
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This case report describes a 43-year-old woman who presented to an acute medical team with a 3-day history of worsening diplopia.

Miller Fisher syndrome (MFS) is characterized by the acute onset of external ophthalmoparesis, ataxia, and areflexia,1 and it is highly correlated with the presence of anti-GQ1b antibodies.2 Here we present a case with a limited variant of MFS characterized by mild ophthalmoparesis, pupillary unresponsiveness, lid twitches, and lid hops in the presence of an extremely high anti-GQ1b antibody level differing from the previously described tumor necrosis factor α (TNFα) antagonist–associated MFS cases.3,4

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