A Case of Miller-Fisher Syndrome with Syndrome of Inappropriate Secretion of Antidiuretic Hormone

Shunya Fujiwara; Yasuhiro Manabe; Yumiko Nakano; Yoshio Omote; Hisashi Narai; Koji Abe

doi:10.1159/000516919

A Case of Miller-Fisher Syndrome with Syndrome of Inappropriate Secretion of Antidiuretic Hormone

Case Rep Neurol. 2021 Jun 14;13(2):380-383. doi: 10.1159/000516919. eCollection 2021 May-Aug.

Authors

Shunya Fujiwara¹, Yasuhiro Manabe¹, Yumiko Nakano¹, Yoshio Omote¹, Hisashi Narai¹, Koji Abe²

Affiliations

¹ Department of Neurology, National Hospital Organization Okayama Medical Center, Okayama, Japan.
² Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan.

Abstract

We report a 72-year-old woman with Miller-Fisher syndrome (MFS) with syndrome of inappropriate secretion of antidiuretic hormone (SIADH). She developed diplopia and unsteady gait a week after an upper respiratory infection. Neurologic examination revealed ophthalmoplegia, ataxia, symmetrical weakness, numbness, and areflexia. She underwent intravenous immunoglobulin therapy. Her serum sodium concentration decreased to 119 mEq/L on day 12. She had low plasma osmolarity (254 mosm/kg), high urine osmolarity (457 mosm/kg), and high urine sodium level (73 mEq/L), while the blood level of antidiuretic hormone was normal. Anti-GD1b immunoglobulin G (IgG), -GQ1b IgG, -GT1a IgG, and -Gal-C IgM antibodies were positive. We diagnosed her with MFS overlapping with SIADH. Four weeks after onset, her symptoms recovered. The elevation of anti-GD1b, -GQ1b, and -GT1a antibodies that recognize disialosyl residue may be pathologically related to SIADH.

Keywords: Hyponatremia; Miller-Fisher syndrome; Syndrome of inappropriate secretion of antidiuretic hormone.

Publication types

Case Reports