Case 3-2015: A Woman with Abdominal Pain, Dyspnea, and Diplopia

New England Journal of Medicine 372(17):1674 (2015) PMID 25901441

To the Editor: In the case of a 60-year-old woman with abdominal pain, dyspnea, and diplopia who received a diagnosis of botulism (Jan. 22 issue),1 one of the differential diagnoses was the Guillain–Barré syndrome. We would like to point out that variants of the Guillain–Barré syndrome, such as the Miller Fisher syndrome and the pharyngeal–cervical–brachial variant, can present with a descending pattern of paralysis that is indistinguishable from botulism. This is particularly true in Asian countries, where the prevalence of these variants is much higher. In our institutional experience of 67 patients with the Miller Fisher syndrome, almost half (31 . . .

DOI: 10.1056/NEJMc1502189