Lupus Patient Develops Miller Fisher Variant of Guillain-Barré Syndrome

GBS has many variants (see Table 2). Although rare, Miller Fisher syndrome typically presents with ophthalmoplegia, ataxia and areflexia. GBS may also present as new- and acute-onset SLE.

(click for larger image) Table 2: Guillain-Barré Syndrome Variants

Prompt recognition of MFS (as well as other GBS variants) is urgent given treatment challenges. Overall, the prog­nosis is good with early diagnosis of SLE and GBS. No set standard for treatment exists, so therapies are usually guided by disease severity.

Our patient responded well, with complete resolution of her neurological symptoms following plasma exchange and steroid administration. This patient had discoid lupus, positive anti-dsDNA and low complements, but after her GBS resolved, she developed proteinuria of 8 grams and underwent a renal biopsy. Her biopsy confirmed membranous glomerulonephritis, which was treated with mycophenolate mofetil 1,500 mg twice daily, along with prednisone and hydroxychloroquine 200 mg twice daily. She responded to this therapy with a decrease in proteinuria.

Bottom line: Be very diligent in SLE patients when they have persistently positive serologies. Our patient had MFS as unusual neurologic and renal complications of SLE. Both were successfully treated, and she is doing well at present.

Dr. Bradley

Sedrick Bradley, MD, is a rheumatology fellow at Ochsner Medical Center, New Orleans. He completed his residency at the University of Mississippi Medical Center, Jackson, Miss. His clinical and research interests include systemic lupus erythematosus and the role of T cell homeostasis in rheumatoid arthritis.

Dr. Patel

Nirupa J. Patel, MD, is a clinical associate professor of medicine in the Section of Rheumatology at LSU Health Sciences Center, New Orleans. Her special interests include HIV infection and myositis.

References

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