An atypical case of Guillain-Barré: overlap of Miller Fisher syndrome with pharyngeal-cervical-brachial variant

Abstract

The patient was a 30-year-old female. She had developed dysphagia three days prior to admission. Initially, she only had problem swallowing solids but later the problem progressed to liquids, and after that dysphonia was added. She was visited by a first-level doctor who diagnosed her problem as pharyngotonsillitis and treated her with amoxicillin + clavulanate without improvement. Two days later, diplopia was added, which led her to come to our hospital. Upon arrival, the vital signs were recorded as blood pressure 120/70 mmHg, respiratory rate 18 breaths per minute, temperature 35.7 °C, and O2 saturation 98% in room air. She was alert, oriented in three spheres, normoreflexic, had isochoric pupils with ptosis when making a pathetic look, and had preserved motor and sensory function of the facial nerve. She also had dysphonia, inability to swallow, with difficulty to manage secretions. She had normal thorax with adequate ventilatory mechanics, lung fields with adequate air entry and exit, rhythmic precordium without aggregated auscultator phenomena, globular abdomen at the expense of panniculus adiposus, preserved peristalsis, pelvic limbs with 1/5 bilateral loss of strength, preserved sensitivity, bilateral areflexia, thoracic limbs strength 3/5 bilateral, and ataxic gait.