A case report of thrombocytopenic COVID-19 and Miller-Fisher syndrome on a concurrent chronic immune neuropathy.

RATIONALE: Miller-Fisher syndrome (MFS) is a rare subtype of Guillain-Barre syndrome with classic features of ataxia, areflexia, and ophthalmoplegia that can be caused by a preceding infection including COVID-19. We present a current, asymptomatic thrombocytopenic COVID-19 infection as a cause of MFS in a 60-year-old male with a concurrent chronic immune neuropathy. PATIENT CONCERNS: A 60-year-old male presenting with acute symptoms of MFS including ataxia, areflexia, and ophthalmoplegia on a chronic immune neuropathy for at least 1 year and concurrent asymptomatic COVID-19 positive infection. DIAGNOSIS: MFS suspected secondary to a current thrombocytopenic COVID-19 infection. INTERVENTIONS: Five days of intravenous immune globulin with continued monthly intravenous immune globulin as an outpatient, follow-up long-term in a neuromuscular clinic, electromyography as an outpatient, and continued physical therapy. OUTCOMES: The patient significantly improved after initial treatment. LESSONS: The full effect of COVID-19 on the various Guillain-Barre syndrome subtypes is unknown, although it clearly can be a cause of the various variants including being caused by a current, asymptomatic infection.

Isolated Infratentorial Posterior Reversible Encephalopathy Syndrome (PRES) in Nephrotic Syndrome: A Case Report.

We present a case of infratentorial variant posterior reversible encephalopathy syndrome (PRES), which is a very rare presentation of PRES. Atypical PRES is more common than the typical parieto-occipital PRES. We present a 43-year-old male who presented with acute change in mentation, left gaze deviation, and paraparesis with initial blood pressures of 230/120 with anasarca. In the present admission, his CT showed diffuse infratentorial hypodensity. Computed tomography angiography (CTA) was negative for large vessel occlusion. MRI of the brain without contrast showed fluid-attenuated inversion recovery (FLAIR) change diffusely in the brainstem but also extended to the cerebellum and occipital lobe, along with diffusion restriction seen in different regions, including the brainstem and cortex. The patient improved clinically with the improvement of blood pressure and follow-up imaging in five weeks showed improvement of imaging findings. This presentation helps understand the approach to patients presenting with brainstem edema in the acute phase.