A rare neurological complication of COVID-19: Pediatric Miller Fisher Syndrome. A case report

Yerdan Mukhaliyev 1 * , Ulmira Rahmatulla 1, Amina Mayufi 1, Zhansaya Zhylkybay 1
More Detail
1 Department of Pediatric Infectious Diseases, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
* Corresponding Author
J CLIN MED KAZ, Volume 20, Issue 6, pp. 73-77. https://doi.org/10.23950/jcmk/14008
OPEN ACCESS 842 Views 817 Downloads
Download Full Text (PDF)

ABSTRACT

The SARS-CoV-2 pandemic has significantly transformed the world. While it was initially viewed as a respiratory virus, it has now been found to cause cardiovascular, gastrointestinal, and psychological complications. Moreover, the nervous system (NS) is also greatly affected. Research has identified dizziness, headaches, as well as disturbances in one's taste and smell abilities as the most frequent symptoms of NS involvement. Even more significant changes may occur in patients who get infected with SARS CoV-2, such as the development of acute cerebrovascular disorders (stroke), multiple sclerosis, acute disseminated encephalitis, Guillain-Barré syndrome, encephalitis, and myelitis. It is important to note these potential complications and monitor patients closely. A retrospective study conducted in Wuhan, China revealed that CNS (central nervous system) involvement occurred three times more frequently than PNS (peripheral nervous system) involvement. This emphasizes the critical importance of studying and describing CNS manifestations. This case report depicts Miller Fisher syndrome in a 5-month-old infant after SARS CoV-2 infection and explores literature on pediatric cases and potential pathogenic mechanisms.
Keywords: SARS-CoV-2, Miller Fisher Syndrome, COVID-19, neurological complications, immune-mediated neuropathy, anti-GQ1b.

CITATION

Mukhaliyev Y, Rahmatulla U, Mayufi A, Zhylkybay Z. A rare neurological complication of COVID-19: Pediatric Miller Fisher Syndrome. A case report. J CLIN MED KAZ. 2023;20(6):73-7. https://doi.org/10.23950/jcmk/14008

REFERENCES

  • Lantos JE, Strauss SB, Lin E. COVID-19-Associated Miller Fisher Syndrome: MRI Findings. AJNR Am J Neuroradiol. 2020; 41(7):1184-1186. https://doi.org/10.3174/ajnr.A6609
  • Ma YM, Liu TK, Wong V. Guillain-Barre syndrome in southern Chinese children: 32 year experience in Hong Kong. Pediatr Int. 2010; 52(1):13-9. https://doi.org/10.1111/j.1442-200X.2009.02951.x
  • Rath J, Zulehner G, Schober B, Grisold A, Krenn M, Cetin H, Zimprich F. Cerebrospinal fluid analysis in Guillain-Barré syndrome: value of albumin quotients. J Neurol. 2021; 268(9):3294-3300. https://doi.org/10.1007/s00415-021-10479-9
  • Poyraz T. Miller Fisher Syndrome Associated With COVID-19: A History of Molecular Mimicry and an Up-to-Date Review of the Literature. Cureus. 2023; 15(8):e43111. https://doi.org/10.7759/cureus.43111
  • Zhang L, Ma L, Zhou L, Sun L, Han C, Fang Q. Miller-Fisher syndrome with positive anti-GD1b and anti-GM1 antibodies combined with multiple autoimmune antibodies: A case report. Medicine (Baltimore). 2023; 102(34):e34969. https://doi.org/10.1097/MD.0000000000034969
  • Gigli GL, Bax F, Marini A, Pellitteri G, Scalise A, Surcinelli A, Valente M. Guillain-Barré syndrome in the COVID-19 era: just an occasional cluster? J Neurol. 2021; 268(4):1195-1197. https://doi.org/10.1007/s00415-020-09911-3
  • Favas TT, Dev P, Chaurasia RN, Chakravarty K, Mishra R, Joshi D, Mishra VN, Kumar A, Singh VK, Pandey M, Pathak A. Neurological manifestations of COVID-19: a systematic review and meta-analysis of proportions. Neurol Sci. 2020; 41(12):3437-3470. https://doi.org/10.1007/s10072-020-04801-y
  • Neophytou P, Artemiadis A, Hadjigeorgiou GM, Zis P. Miller Fischer syndrome after COVID-19 infection and vaccine: a systematic review. Acta Neurol Belg. 2023; 123(5):1693-1701. https://doi.org/10.1007/s13760-023-02336-5
  • Malko V.A., Klimov P.V., Topuzova M.P., Yarush I.V., Simakov K.V., Alekseeva T.M. Miller Fisher syndrome developed after a previous COVID-19 infection (case report). Neuromuscular Diseases. 2021; 11(2):56-60. https://doi.org/10.17650/2222-8721-2021-11-2-56-60
  • Raisi-Estabragh Z, McCracken C, Bethell MS, Cooper J, Cooper C, Caulfield MJ, Munroe PB, Harvey NC, Petersen SE. Greater risk of severe COVID-19 in Black, Asian and Minority Ethnic populations is not explained by cardiometabolic, socioeconomic or behavioural factors, or by 25(OH)-vitamin D status: study of 1326 cases from the UK Biobank. J Public Health (Oxf). 2020; 42(3):451-460. https://doi.org/10.1093/pubmed/fdaa095
  • Huo L, Xu KL, Wang H. Clinical features of SARS-CoV-2-associated encephalitis and meningitis amid COVID-19 pandemic. World J Clin Cases. 2021; 9(5):1058-1078. https://doi.org/10.12998/wjcc.v9.i5.1058
  • Biswas S, Ghosh R, Mandal A, Pandit A, Roy D, Sengupta S, De K, Swaika BC, Benito-León J. COVID-19 Induced Miller Fisher Syndrome Presenting With Autonomic Dysfunction: A Unique Case Report and Review of Literature. Neurohospitalist. 2022; 12(1):111-116. https://doi.org/10.1177/19418744211016709
  • Keyhanian K, Umeton RP, Mohit B, Davoudi V, Hajighasemi F, Ghasemi M. SARS-CoV-2 and nervous system: From pathogenesis to clinical manifestation. J Neuroimmunol. 2020; 350:577436. https://doi.org/10.1016/j.jneuroim.2020.577436
  • Moriguchi T, Harii N, Goto J, Harada D, Sugawara H, Takamino J, Ueno M, Sakata H, Kondo K, Myose N, Nakao A, Takeda M, Haro H, Inoue O, Suzuki-Inoue K, Kubokawa K, Ogihara S, Sasaki T, Kinouchi H, Kojin H, Ito M, Onishi H, Shimizu T, Sasaki Y, Enomoto N, Ishihara H, Furuya S, Yamamoto T, Shimada S. A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. Int J Infect Dis. 2020; 94:55-58. https://doi.org/10.1016/j.ijid.2020.03.062
  • Almutairi MM, Sivandzade F, Albekairi TH, Alqahtani F, Cucullo L. Neuroinflammation and Its Impact on the Pathogenesis of COVID-19. Front Med (Lausanne). 2021; 8:745789. https://doi.org/10.3389/fmed.2021.745789
  • Acharya A, Kevadiya BD, Gendelman HE, Byrareddy SN. SARS-CoV-2 Infection Leads to Neurological Dysfunction. J Neuroimmune Pharmacol. 2020; 15(2):167-173. https://doi.org/10.1007/s11481-020-09924-9
  • Sher EK, Ćosović A, Džidić-Krivić A, Farhat EK, Pinjić E, Sher F. Covid-19 a triggering factor of autoimmune and multi-inflammatory diseases. Life Sci. 2023; 319:121531. https://doi.org/10.1016/j.lfs.2023.121531
  • Yaqoob A, Dar W, Khuja Z, Bukhari I, Raina A, Ganie H, Chandra A, Wani M, Asimi R, Wani F. Miller Fisher syndrome associated with COVID 19. J Family Med Prim Care. 2022; 11(7):4023-4025. https://doi.org/10.4103/jfmpc.jfmpc_1864_21
  • Faulkner L, Scott S, Flint N. Miller-Fisher syndrome associated with SARS-CoV-2: a case report. Microbes Infect. 2022; 24(5):104954. https://doi.org/10.1016/j.micinf.2022.104954
  • Montalvan V, Lee J, Bueso T, De Toledo J, Rivas K. Neurological manifestations of COVID-19 and other coronavirus infections: A systematic review. Clin Neurol Neurosurg. 2020; 194:105921. https://doi.org/10.1016/j.clineuro.2020.105921
  • Wu X, Wang Y, Xi ZQ. Clinical and antibodies analysis of anti-GQ1b antibody syndrome: a case series of 15 patients. Acta Neurol Belg. 2023; 123(3):839-847. https://doi.org/10.1007/s13760-022-01940-1
  • Noioso CM, Bevilacqua L, Acerra GM, Della Valle P, Serio M, Vinciguerra C, Piscosquito G, Toriello A, Barone P, Iovino A. Miller Fisher syndrome: an updated narrative review. Front Neurol. 2023; 14:1250774. https://doi.org/10.3389/fneur.2023.1250774
  • Leonhard SE, Mandarakas MR, Gondim FAA, Bateman K, Ferreira MLB, Cornblath DR, van Doorn PA, Dourado ME, Hughes RAC, Islam B, Kusunoki S, Pardo CA, Reisin R, Sejvar JJ, Shahrizaila N, Soares C, Umapathi T, Wang Y, Yiu EM, Willison HJ, Jacobs BC. Diagnosis and management of Guillain-Barré syndrome in ten steps. Nat Rev Neurol. 2019; 15(11):671-683. https://doi.org/10.1038/s41582-019-0250-9
  • Martins-Filho PR, Pereira de Andrade AL, Pereira de Andrade AJ, Moura da Silva MD, de Souza Araújo AA, Nunes PS, Santos VS, Ferreira LC, de Aquino Neves EL, Quintans-Júnior LJ. Miller Fisher Syndrome in Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Systematic Review. J Clin Neurol. 2021; 17(4):541-545. https://doi.org/10.3988/jcn.2021.17.4.541
  • Han MS, Um J, Lee EJ, Kim KM, Chang SH, Lee H, Kim YK, Choi YY, Cho EY, Kim DH, Choi JH, Lee J, Kim M, Chung KH, Min HS, Choe YJ, Lim DG, Park JS, Choi EH. Antibody Responses to SARS-CoV-2 in Children With COVID-19. J Pediatric Infect Dis Soc. 2022; 11(6):267-273. https://doi.org/10.1093/jpids/piac012
  • Shomuradova S S, & Aminova A A. Organization of early diagnosis and prevention of thymomegaly in children. World Bulletin of Public Health. 2023; 22:1-4. Retrieved from https://scholarexpress.net/index.php/wbph/article/view/2636
  • Jahangir M, Craig B, Raheleh A, Chapter 12 - Thymus Tumors, Epidemiology of Endocrine Tumors, Elsevier, 2020, Pages 283-294, ISBN 9780128221877.
  • Durmaz S C. Neurological Findings of COVID-19 in children and effects on children with neuromuscular disease. Multidisciplinary Approaches To Covid-19. 2022:127-137.