Miller Fisher syndrome (MFS) is a triad of total
external ophthalmoplegia,
ataxia, and areflexia, while
botulism has the usual clinical presentation of involvement of cranial muscles and
palsies with blurred vision,
diplopia, ptosis, dilated pupils, and
facial paralysis, caused by a bacterial
neurotoxin which attacks
proteins involved in presynaptic vesicle release. In this report, we needed to make the differential diagnosis between MFS and
botulism in a patient who presented with acute
ophthalmoparesis and a history of
diarrhea three days before, which started two days after consuming tinned food. Routine laboratory, neurophysiologic, and imaging investigations were normal. A clinical diagnosis of
Miller Fisher syndrome was reached by anti-
ganglioside GQ1B and GM1 Ig G and M antibody investigations which proved positive. The patient was treated with
intravenous immunoglobulin two weeks after (in the late period) the symptoms started and he has recovered completely. Systemic
autoimmune diseases should be considered in patients with bilateral
ophthalmoparesis. As in the present patient, the evaluation of specific
antibodies helps in the diagnosis and thus early effective treatment is possible.