P3385 - Adynamic Ileus in Miller Fisher Syndrome

Jefferson Tran, , Jose Matus, MD, Katrina Sykes, , Karen Eskue, , Thomas Tran, MD
TMC, Denison, TX

Introduction: Miller Fisher syndrome (MFS) is a rare neurological disease that is characterized by the clinical triad of ophthalmoplegia, ataxia, and areflexia. Adynamic ileus is an extremely rare presentation of MFS with only a few cases reported in the medical literature.

Case Description/Methods: The patient is a 61-year-old man who was admitted to the hospital for 2 weeks of worsening diffuse weakness, diplopia, dizziness, and ataxia. He also presented with sudden onset of nausea, vomiting, intolerance of any oral intake, abdominal distension, and obstipation. His neurological examination was significant for paralysis of extra-ocular muscles and complete absence of tendon reflexes. Abdominal examination showed moderate abdominal distension with no bowel sounds. The patient had negative brain CT and MRI with no evidence of a stroke. Lumbar puncture showed normal cerebrospinal fluid. Neurology diagnosed him with MFS, which was confirmed by positive serum anti-GQ 1b antibodies. KUB and abdominal CT showed dilated loops of small bowel with no transition point consistent with ileus. He was diagnosed with adynamic ileus associated with MFS. NGT was placed for decompression. Metoclopramide was started at 10 mg IV every 6 hours. The patient’s weakness deteriorated to the point of impending respiratory failure. He was intubated and ventilated. He went into atrial flutter, treated with anticoagulation and cardioversion back to normal sinus rhythm. IV Immunoglobulin 0.4 mg/kg/day for 5 days was initiated for MFS. Plasmapheresis was planned for second line treatment if immunoglobulin failed. The patient gradually improved with both ileus and MFS. He started to regain bowel functions with passing of flatus and stool. He was extubated without problems. The NGT and metoclopramide were discontinued, and a diet was reintroduced with clear liquids. His diet was slowly advanced to regular diet. The patient was discharged after 17 days in the hospital and has done well with no recurrence of symptoms.

Discussion: MFS is considered a rare variant of Guillain-Barré syndrome. There are only a few case reports of ileus in MFS in the medical literature. Most patients have positive serum anti-GQ 1b antibodies. Adynamic ileus is postulated to be caused by a sympathetic-parasympathetic imbalance of the enteric nervous system from an immune reaction. Treatment of MFS consists of immunoglobulin and plasmapheresis. Adynamic ileus typically improves once MFS is under control as illustrated by this case.


Disclosures:


Jefferson Tran, , Jose Matus, MD, Katrina Sykes, , Karen Eskue, , Thomas Tran, MD. P3385 - Adynamic Ileus in Miller Fisher Syndrome, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.