Atypical Miller-Fisher Syndrome after COVID-19 and sleeve gastrectomy: contribution of neurochemical markers to early diagnosis

ABSTRACT

Background The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), began in late 2019. More recently, there have been sporadic case reports on development of Miller-Fisher Syndrome (MFS), a rare variant of Guillain-Barré Syndrome (GBS) in COVID-19 patients. Case report We reported herein the case of a French young women presenting with ophtalmoplegia, cerebellar ataxia and universal areflexia following a bariatric surgery (sleeve gastrectomy). A concomitant COVID-19 diagnosis was retained based on microbiological testing. The patient was successfully treated after high-dose intravenous thiamine, but areflexia persisted. Underlying COVID-19 related MFS was established on physical examination and confirmed by pathologic neurophysiological findings and elevated level of phosphorylated neurofilament heavy chain protein (pNfH) in cerebrospinal fluid analysis. Conclusion GBS and its variants after SARS-CoV-2 infection are extremely rare. The measurement of pNfH should be considered as an easy tool to detect an early affection of the peripheral nervous system.