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Título

MILLER FISHER SYNDROME: CRACK USER RECURRENCE

RESUMO

Case presentation: A 54-year-old man sought hospital care due to low fever, productive cough, urinary retention, low back pain, visual alteration, and diffuse paresthesia for 2 days. Miller Fisher Syndrome (MFS) was diagnosed and treated with immunoglobulin. Crack user. Irregular treatment of hepatitis C. On examination, patient in regular general condition, pain facies, eupneic, photoreactive isochoric pupils, extrinsic ocular muscles hampered in the left and bilateral lower gazes, reduced overall strength with difficulty in overcoming resistance, areflexia in lower limbs and hyporeflexia in the upper limbs, appendicular ataxia, other aspects of the neurological examination without abnormalities. Admission exams for infectious screening without changes. Lumbar puncture was performed, clear and colorless CSF, glucose 61, protein 114, 1 cell/mm³, 100% MNM, gram-negative, ink negative, lactate 1.7, VDRL negative. Cranial CT angiography without acute injuries. The patient's general condition worsened, evolving with vomiting, plethoric facies, worsening of left lumbar pain, dyspnea with supplemental oxygen therapy, and need for urinary catheterization. A 2019 electroneuromyography exam showed an old and partially reinnervated demyelinating and axonal process in the upper and lower limbs; signs of diffuse neuropathy involving cranial nerves with signs of old reinnervation, no evidence of active disease. Diagnosed with a relapse of Miller Fisher Syndrome, the patient started with intravenous immunoglobulin for five days. After clinical and neurological improvement, he was discharged from the hospital.Discussion: Considered a rare variant of Guillain-Barré (GBS), MFS is a multifocal neuropathy characterized by the clinical triad of ophthalmoplegia, ataxia, and areflexia. The recurrence of MFS episodes is extremely rare, with only 37 cases reported in the literature until 2016. This fact, associated with the chronic use of crack by the patient, brings curiosity concerning the recurrence of FMS itself. A liquor dissociation appears in 90% of cases as in the case presented. The third cranial nerve is frequently the most affected.
Final comments: Clinical history and complementary exams, associated with improvement of the condition with immunoglobulin, strengthen the diagnosis of FMS. The use of crack, considered a risk factor, associated with liver disease and previous acute respiratory infection, may have favored recurrence.

Palavras Chave

Miller Fisher syndrome; crack user; neuropathy

Área

Neuroinfecção