P1287 - From Neurological Enigma to Esophageal Puzzle: Unveiling a Case of Achalasia Coexisting With Miller Fischer Variant of GBS

Sana Saleem, MD¹, Petro Shafranyuk, MD², Saria Adnan Sultan, DO¹, Mohammed A. Khan, MS, DO³, Shana Kothari, MD⁴, Ashirf Al-Ghanoudi, MD, MPH, FACG^2
1Franciscan Health, Chicago, IL; ²Franciscan Health Olympia Fields, Olympia Fields, IL; ³Franciscan Health Olympia Fields, Chicago, IL; ⁴Franciscan Health, Olympia Fields, IL

Introduction: Miller Fisher syndrome (MFS) is a rare neurological disorder, a subtype of Guillain-Barré syndrome (GBS) thought to result from an acute autoimmune response to a preceding infection. Typical manifestations encompass ophthalmoplegia, diminished reflexes, muscle weakness, and potential respiratory difficulties leading to respiratory failure. Achalasia is a disorder affecting the motor function of the esophagus, characterized by malfunctioning relaxation of the lower esophageal sphincter. The number of reported cases has been relatively limited for achalasia in the setting of GBS. To the best of our knowledge no reports were documented with simultaneous occurrence of MFS, and achalasia. Here, we present a patient previously diagnosed with Miller-Fisher syndrome with a rapid onset of achalasia.

Case Description/Methods: A 45-year-old female patient with recent diagnosis of seronegative Miller-Fisher variant GBS and sleeve gastrectomy presented with dyspnea and fevers. The patient's initial presentation for GBS occurred in 2022 where she exhibited symptoms of progressive dyspnea, ophthalmoparesis, facial weakness, and areflexia. Subsequently, she experienced respiratory failure requiring intubation. All workup was unremarkable accept Anti GQ1 antibody which came back positive. Despite plasma exchange she did not respond to multiple spontaneous breathing trials and underwent tracheostomy placement. PEG tube was a inserted due to the severity of
her dysphagia. The patient later presented to our facility with severe respiratory distress and underwent CTA PE showing fluid filled mid-distal esophagus. Esophogram uncovered severe gastroesophageal reflux and contrast stasis with occasional tertiary contractions suggestive of an esophageal motility disorder. Highly suggestive of achalasia. Further workup including esophageal manometry/motility study have been recommended and will be done as outpatient.

Discussion: Achalasia with Miller-Fisher presents notable challenges. It is triggered by an autoimmune response due to a precipitating acute illness causing loss of inhibitory ganglion cells of the myenteric plexus. Timely diagnosis and implementation of treatment are essential. Pneumatic dilation, Heller myotomy, and pharmacological approaches such as botulinum toxin injection or calcium channel blockers encompass the treatment options. It is crucial to understand the
underlying mechanisms and enhance management strategies for individuals experiencing such condition together.



Disclosures:


Sana Saleem, MD¹, Petro Shafranyuk, MD², Saria Adnan Sultan, DO¹, Mohammed A. Khan, MS, DO³, Shana Kothari, MD⁴, Ashirf Al-Ghanoudi, MD, MPH, FACG². P1287 - From Neurological Enigma to Esophageal Puzzle: Unveiling a Case of Achalasia Coexisting With Miller Fischer Variant of GBS, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.