That Khaing Zin, Lim Kai Xiong, Wong Marc Hai Liang
Internal Medicine, Sengkang General Hospital, Singapore, SGP.
Cureus. 2025 May 12;17(5):e83981. doi: 10.7759/cureus.83981. eCollection 2025 May.
We report the case of a 70-year-old man with an incomplete form of Miller Fisher syndrome (MFS) complicated by syndrome of inappropriate secretion of antidiuretic hormone (SIADH). He presented with diplopia two weeks after a respiratory infection. Neurological examination showed bilateral pupil-sparing third nerve palsy, with normal reflexes, gait, coordination, power, and sensation. Serum sodium was markedly low (112 mmol/L) at presentation, with low serum osmolality, high urine sodium, and elevated urine osmolality. Anti-GQ1b IgG antibodies were positive, confirming the diagnosis of MFS. He was managed supportively with fluid restriction and oral sodium chloride tablets. He did not receive intravenous immunoglobulin. Symptoms resolved completely after eight weeks. This case underscores the importance of recognizing incomplete presentations of MFS and highlights the rare but clinically significant complication of SIADH. Early identification and appropriate management of both conditions are critical to improving patient outcomes and preventing complications.
我们报告了一例70岁男性患者，患有不完全型米勒-费雪综合征（MFS），并伴有抗利尿激素分泌不当综合征（SIADH）。他在呼吸道感染两周后出现复视。神经系统检查显示双侧动眼神经麻痹且瞳孔不受累，反射、步态、协调能力、肌力和感觉均正常。就诊时血清钠显著降低（112 mmol/L），血清渗透压降低，尿钠升高，尿渗透压升高。抗GQ1b IgG抗体呈阳性，确诊为MFS。对他采取了限制液体摄入和口服氯化钠片的支持治疗。他未接受静脉注射免疫球蛋白治疗。八周后症状完全缓解。该病例强调了认识MFS不完全表现的重要性，并突出了SIADH这种罕见但具有临床意义的并发症。对这两种情况进行早期识别和适当管理对于改善患者预后及预防并发症至关重要。
