Case ReportIsolated Ptosis as Acute Ophthalmoplegia Without Ataxia, Positive for Anti-GQ1b Immunoglobulin G
Introduction
Anti-GQ1b antibodies have been strongly associated in the literature with Miller Fisher Syndrome [1], with acute ophthalmoplegia associated with Guillain-Barré, and with isolated ophthalmoplegia [2], [3]. Anti-GQ1b IgG antibody syndrome comprises a wide range of disorders presenting with ophthalmoplegia and ataxia [4]. Acute ophthalmoplegia associated with anti-GQ1b antibody manifests as various combinations of external and internal ophthalmoplegia, including ptosis [3]. Reported here is the case of a patient with anti-GQ1b antibody positivity who had bilateral ptosis as the only manifestation of acute ophthalmoplegia and areflexia. The case falls within the spectrum of anti-GQ1b IgG antibody syndrome illnesses.
Section snippets
Case Report
A 2-year-old boy presented with a history of fever and cough for 6-7 days. He had had a similar episode a year previously, for which he was given salbutamol nebulizations. On examination, he was found to be febrile and tachypneic, with diffuse rhonchi on chest auscultation. Investigations revealed a total leukocyte count of 10,000/mm3 with 70% neutrophils, 27% lymphocytes, and 1% eosinophils; blood cultures were found to be sterile. Chest radiography revealed bilateral hyperinflation with
Discussion
Miller Fisher syndrome, which is characterized by ophthalmoplegia, ataxia, and areflexia [5], has been strongly associated with anti-GQ1b IgG antibodies [1], [2], [6]. Motor strength is usually preserved. Anti-GQ1b IgG antibody has also been found in patients with Guillain-Barré syndrome who had ophthalmoparesis. Also, anti-GQ1b IgG antibody has also been closely associated with Bickerstaff's brain stem encephalitis, a clinical entity described in patients with acute onset of external
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