Background and aims: Miller Fisher Syndrome (MFS) is an uncommon variant of the spectrum of Guillain Barré Syndrome (GBS). MFS relapses are rare and often described after long asymptomatic intervals. GBS-MFS spectrum has been reported in association with SARS-COV2 infection. We present a SARS-COV2 associated GBS-MFS relapse. Methods: We detail patient's characteristics and compare with previous reports. Results: A 60-year-old man, diagnosed with GBS-MFS in March 2020, was admitted at Emergency Department in February 2021 with incomplete asymmetric ophthalmoplegia, ataxia, areflexia, four limbs weakness and paraesthesia and mild bifrontal oppressive headache. CSF analysis was unremarkable. Nerve conduction studies on day 7 showed a motor demyelinating polyneuropathy. Serum anti-GQ1b IgG antibodies were negative. Molecular SARS-COV2 test was positive although he was asymptomatic, except for mild fever three days after onset, at the same time with neurological symptoms worsening. Blood tests revealed mild leukopenia and CRP elevation. He was treated with intravenous low dose dexamethasone, subcutaneous enoxaparin for 10 days and with intravenous immunoglobulins for 5 days. Neurological symptoms resolved after 20 days, concurrently nasopharyngeal swab tested negative. Compared to previous reported SARS-COV2 associated GBS-MFS, in our case neurological symptoms came first, with para-infectious rather than post-infectious immune mediated mechanism. Latency of not SARS-COV2 triggered relapses was longer (median 7 years) with usually positive anti-GQ1b IgG antibodies. Conclusions: To the best of our knowledge, this is the first GBS-MFS recurrence description during SARS-COV2 infection. Its underlying immune mechanism seems to differ from SARS-COV2 related monophasic reports, with shorter latency and probably different antibody profile than not-SARS-COV2 linked relapses.
Guillain Barré- Miller fisher syndrome relapse during SARS-CoV2 infection - A case report