Miller Fisher syndrome following Pfizer COVID-19 vaccine

Yoon

Acta Neuro Scandinavica

et al. 2022

Background and Purpose Miller Fisher syndrome (MFS), a variant of Guillain–Barré Syndrome (GBS), could be underestimated in evaluations of its adverse events (AEs) following COVID‐19 vaccination. We aimed to identify and characterize MFS following COVID‐19 vaccination. Materials and Methods Relevant studies reported on during the COVID‐19 pandemic were identified in the MEDLINE, Embase, and other databases. Results Nine cases of MFS following COVID‐19 vaccination from various regions were included. Unlike MFS following COVID‐19 infection, patients with MFS following COVID‐19 vaccination frequently presented with anti‐GQ1b antibody positivity (44%, 4/9). Unlike GBS following COVID‐19 vaccination, only two of nine (22%) cases of MFS following COVID‐19 vaccination had developed after viral‐vector‐related vaccine administration. Conclusions Miller Fisher syndrome following COVID‐19 vaccination seems to have a different pathophysiology from MFS following COVID‐19 infection and GBS following COVID‐19 vaccination. This neurological syndrome with a rare incidence and difficulty in diagnosis should be considered an AE of COVID‐19 vaccination.

“…This resulted in nine articles finally being analyzed for this review. 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 A flow diagram illustrating the full search process is shown in Figure 1 .…”

Section: Resultsmentioning

confidence: 99%

“…We also searched articles that cited any of or were references of the initially included studies. This resulted in nine articles finally being analyzed for this review 8–16 . A flow diagram illustrating the full search process is shown in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

Miller Fisher syndrome following COVID ‐19 vaccines: A scoping review

Yoon

Acta Neuro Scandinavica

et al. 2022

“…The screening of abstracts revealed 4 cases reporting MFS after COVID-19 vaccination. Michaelson et al, [ 17 ] Abičić et al, [ 18 ] and Nishiguchi et al [ 19 ] reported the neurological spectrum of MFS after Pfizer-BioNTech vaccines. At the same time, Dang and Bryson [ 20 ] described an overlapping syndrome of MFS and GBS after the Oxford-Astrazeneca vaccination.…”

Section: Discussionmentioning

confidence: 99%

Miller Fisher syndrome after COVID-19 vaccination: Case report and review of literature

et al. 2022

Rationale: Miller Fisher syndrome (MFS) is a rare variant of Guillain-Barre syndrome, classically diagnosed based on the clinical triad of ataxia, areflexia, and ophthalmoplegia. MFS is usually preceded by viral infections and febrile illness; however, only a few cases have been reported after vaccinations. Patient concerns: A 53-year-old hypertensive male presented with a 2-day history of progressive ascending paralysis of the lower limbs along with diplopia and ataxia, 8 days after the first dose of the Sinovac–Coronavac coronavirus disease 2019 (COVID-19) vaccination, with no prior history of any predisposing infections or triggers. Diagnoses: Physical examination showed moderate motor and sensory loss with areflexia in the lower limbs bilaterally. Routine blood investigations and radiological investigations were unremarkable. Cerebrospinal fluid analysis showed albuminocytologic dissociation and nerve conduction studies revealed prolonged latencies with reduced conduction velocities. The diagnosis of MFS was established based on the findings of physical examination, cerebrospinal fluid analysis, and nerve conduction studies. Interventions: A management plan was devised based on intravenous immunoglobulins, pregabalin, and physiotherapy. However, due to certain socioeconomic factors, the patient was managed conservatively with regular physiotherapy sessions. Outcomes: Follow-up after 6 weeks showed remarkable improvement, with complete resolution of symptoms 10 weeks after the discharge. Lessons: This case suggests that MFS is a rare adverse effect after COVID-19 vaccination and additional research is required to substantiate a temporal association. Further studies are needed to understand the pathophysiology behind such complications to enhance the safety of COVID-19 vaccinations in the future.

“…Cases of MFS after influenza and pneumococcal vaccinations have been reported [13,14]. Four cases of MFS caused by COVID-19 vaccination except for our case also have been reported (Table 1) [15][16][17][18]. All four cases were reported after receiving the Pfizer vaccine.…”

Section: Discussionmentioning

confidence: 51%

A case of Miller Fisher syndrome with delayed onset peripheral facial nerve palsy after COVID-19 vaccination: a case report

et al. 2022

Background To prevent the spread of the novel coronavirus disease 2019 (COVID-19) infection, various vaccines have been developed and used in a large number of people worldwide. One of the most commonly used vaccines is the mRNA vaccine developed by Moderna. Although several studies have shown this vaccine to be safe, the full extent of its side effects has not yet been known. Miller-Fisher syndrome (MFS) is a rare condition that manifests ophthalmoplegia, ataxia, and loss of tendon reflexes. It is a subtype of Guillain–Barré syndrome and an immune-mediated disease related to serum IgG anti-GQ1b antibodies. Several vaccines including those for COVID-19 have been reported to induce MFS. However, there have been no reports of MFS following Moderna COVID-19 vaccine administration. Case presentation A 70-year-old man was referred to our hospital due to diplopia that manifested 1 week after receiving the second Moderna vaccine dose. The patient presented with restricted abduction of both eyes, mild ataxia, and loss of tendon reflexes. He was diagnosed with MFS based on his neurological findings and detection of serum anti-GQ1b antibodies. The patient was administered intravenous immunoglobulin, and his symptoms gradually improved. Five days after admission, the patient showed peripheral facial paralysis on the right side. This symptom was suggested to be a delayed onset of peripheral facial nerve palsy following MFS that gradually improved by administration of steroids and antiviral drugs. Conclusion There have been no previous reports of MFS after Moderna COVID-19 vaccination. This case may provide new information about the possible neurological side effects of COVID-19 vaccines.