GQ1b-Seronegative Miller Fisher Syndrome Associated With Pembrolizumab

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Title GQ1b-Seronegative Miller Fisher Syndrome Associated With Pembrolizumab
Creator Kemar E. Green; Anna M. Levine; Jayne H. Ward; David I. Kaufman
Affiliation Department of Neurology and Ophthalmology (KEG, JHW, and DIK), Michigan State University, East Lansing, Michigan; and Michigan State University College of Osteopathic Medicine (AML), East Lansing, Michigan
Abstract A 62-year-old man with a history of metastatic squamous cell carcinoma (SCC) of the scalp, who recently completed 5 cycles of pembrolizumab, presented to the emergency department with 2 weeks of progressive gait ataxia, dysarthria, dysphagia, and diplopia. On physical examination, he had profound areflexia, lower-extremity ataxia, facial diplegia, and ophthalmoplegia. Brain MRI was normal. Lumbar puncture showed albuminocytologic dissociation of 7 white blood cells/µL and protein of 236 mg/dL (normal: 15-45 mg/dL). Additional cerebrospinal fluid (CSF) studies including cytology and flow cytometry were normal. A tentative diagnosis of Miller Fisher syndrome (MFS) was made, and a 5-day course of intravenous immunoglobulin (IVIg) therapy was initiated. Within 2 days, there was marked improvement in facial weakness and ophthalmoplegia. Ganglioside (Asialo-GM1, GM1, GM2, GD1a, GD1b, and GQ1b), acetylcholine receptor (blocking, binding, and modulating), and paraneoplastic (antineuronal nuclear type I/II/III, antiglial nuclear type I, purkinje cell cytoplasmic types I/II/Tr, amphiphysin, CRMP-5, striational, P-/Q-type calcium channel, N-type calcium channel, AChR ganglionic neuronal, and neuronal [V-G] potassium channel) antibodies sent before starting IVIg were within the normal range.
Subject Antibodies, Monoclonal, Humanized / therapeutic use; Antineoplastic Agents, Immunological / therapeutic use; Autoantibodies / blood; Carcinoma, Squamous Cell / drug therapy; Carcinoma, Squamous Cell / pathology; Gangliosides / immunology; Humans; Male; Middle Aged; Miller Fisher Syndrome / blood; Miller Fisher Syndrome / diagnosis; Miller Fisher Syndrome / immunology; Scalp / pathology; Skin Neoplasms / drug therapy; Skin Neoplasms / pathology
OCR Text Show
Date 2019-09
Language eng
Format application/pdf
Type Text
Publication Type Journal Article
Source Journal of Neuro-Ophthalmology, September 2019, Volume 39, Issue 3
Collection Neuro-Ophthalmology Virtual Education Library: Journal of Neuro-Ophthalmology Archives: https://novel.utah.edu/jno/
Publisher Lippincott, Williams & Wilkins
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah
Rights Management © North American Neuro-Ophthalmology Society
ARK ark:/87278/s6z66cht
Setname ehsl_novel_jno
ID 1595905
Reference URL https://collections.lib.utah.edu/ark:/87278/s6z66cht
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