An Atypical Case of Miller Fisher Syndrome: Classic Clinical Triad Despite Negative Anti-GQ1b Antibody.

Miller Fisher syndrome (MFS), a variant of Guillain-Barré syndrome (GBS), was diagnosed in a 30-year-old patient following a mononucleosis infection. The progression of this patient's disease began with the classic triad of symptoms (areflexia, ophthalmoplegia, and ataxia) beginning at the head and progressing downward. Most notably, the diaphragm was spared. Ophthalmoplegia, ataxia, and areflexia were among the most defining of symptoms; however, this patient also presented with restlessness in his extremities and urinary hesitancy. Diagnostic workup of this patient included testing for anti-GQ1B antibodies in addition to a thorough history and physical exam. Initial treatment with intravenous immunoglobulin (IVIG) was unsuccessful. Plasmapheresis was ultimately initiated; however, the patient failed to complete treatment due to iatrogenic complications. The patient failed to return to follow-up appointments to determine recovery status. This case underscores the critical importance of a thorough and systematic diagnostic approach in managing atypical presentations of GBS variants.