Japanese encephalitis virus triggered overlapping Miller Fischer syndrome with Bickerstaff encephalitis in a young Filipino cruise line worker
  • Hussain Hussain
    Larkin Community Hospital, Department of Internal Medicine, Miami, Florida, USA
  • Efrain Garcia
    Larkin Community Hospital, Department of Internal Medicine, Miami, Florida, USA
  • Sohair Angly
    Larkin Community Hospital, Department of Internal Medicine, Miami, Florida, USA
  • Jesus Aviles-Caraballo
    Larkin Community Hospital, Department of Internal Medicine, Miami, Florida, USA
  • Hirania Pages-Vega
    Larkin Community Hospital, Department of Internal Medicine, Miami, Florida, USA
  • Joseph Martinez
    Larkin Community Hospital, Department of Internal Medicine, Miami, Florida, USA
  • Zahraa Saadoon
    University of Baghdad School of Medicine, Department of Internal Medicine, Baghdad, Iraq
  • Luis Mendez
    Larkin Community Hospital, Department of Internal Medicine, Miami, Florida, USA
  • Aya Fadel
    Department of Internal Medicine at Ocean University Medical Center – Hackensack Meridian Health , New Jersey, USA

Keywords

Anti-GQ1b, ataxia, Bickerstaff, HIV, Japanese encephalitis, Miller Fisher, West Nile

Abstract

Japanese encephalitis virus is an RNA flavivirus and one of the rare pathogens that can cause encephalitis. The main vector is the Culex tritaeniorhynchus mosquito. The virus is very close in pathophysiology and structure to the West Nile and St. Louis encephalitis viruses. It is endemic in Asia and Western Pacific areas, mostly during the summer; only a few cases have been reported outside those regions. We present the case of a young Filipino cruise line male worker with signs and symptoms of Japanese encephalitis concomitantly with Miller Fisher syndrome and Bickerstaff brainstem encephalitis. The patient developed obtundation, ataxia, areflexia, flaccid paralysis, and ophthalmoplegia, which were preceded by a few days of constitutional symptoms (fever, malaise, fatigue and anorexia). Physical examination showed various stages of erythema nodosum on the lower extremities. Analysis of cerebrospinal fluid was positive for anti-GQ1b, West Nile IgG and Japanese encephalitis IgM. Despite the neurological complications and bradyarrhythmia occurring during hospitalization, the patient recovered completely under our regimen.

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    Published: 2023-03-18
    Issue: 2023: Vol 10 No 3 (view)

    How to cite:
    1.
    Hussain H, Garcia E, Angly S, Aviles-Caraballo J, Pages-Vega H, Martinez J, Saadoon Z, Mendez L, Fadel A. Japanese encephalitis virus triggered overlapping Miller Fischer syndrome with Bickerstaff encephalitis in a young Filipino cruise line worker. EJCRIM 2023;10 doi:10.12890/2023_003797.

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