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
DOI: https://doi.org/10.12890/2023_003797

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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References

  • Centers for Disease Control and Prevention. Transmission of Japanese encephalitis virus. 2022. Available from https://www.cdc.gov/japaneseencephalitis/transmission/index.html.
  • Amicizia D, Zangrillo F, Lai PL, Iovine M, Panatto D. Overview of Japanese encephalitis disease and its prevention. Focus on IC51 vaccine (IXIARO®). J Prev Med Hyg 2018;59:99–107.
  • Wang G, Li H, Yang X, Guo T, Wang L, Zhao Z, et al. Guillain–Barré syndrome associated with JEV infection. N Engl J Med 2020;383:1188–1190.
  • Kuwabara S. Fisher syndrome and Bickerstaff brainstem encephalitis. Brain Nerve 2015;67:1371–1376.
  • Yaqoob A, Dar W, Khuja Z, Bukhari I, Raina A, Ganie H, et al. Miller Fisher syndrome associated with COVID 19. J Family Med Prim Care 2022;11:4023–4025.
  • Yuki N. Infectious origins of, and molecular mimicry in, Guillain-Barré and Fisher syndromes. Lancet Infect Dis 2001;1:29–37.
  • Communal C, Filleron A, Baron-Joly S, Salet R, Tran T-A. Pediatric Miller Fisher syndrome complicating an Epstein-Barr virus infection. Pediatr Neurol 2016;63:73–75.
  • Shimizu T, Tokuda Y. Miller Fisher syndrome linked to Norovirus infection. BMJ Case Rep 2012;2012:bcr2012007776.
  • Da Silva IRF, Frontera JA, Bispo de Filippis AM, Nascimento OJMD; RIO-GBS-ZIKV Research Group. Neurologic complications associated with the Zika virus in Brazilian adults. JAMA Neurol 2017;74:1190–1198.
  • Edvardsson B, Persson S. Severe bradycardia in a patient with acute ophthalmoparesis without ataxia. Muscle Nerve 2010;41:728–729.
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    Published: 2023-03-18

    Issue: 2023: Vol 10 No 3 (view)

    Section: Articles

    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.