Miller Fisher syndrome following Pfizer COVID-19 vaccine

Neurol Sci. 2022 Mar;43(3):1495-1497. doi: 10.1007/s10072-021-05776-0. Epub 2021 Nov 24.


Introduction: Miller Fisher syndrome (MFS) is a rare variant of Guillain-Barre syndrome characterized by ataxia, areflexia, and ophthalmoplegia. We present a case of MFS following Pfizer COVID-19 vaccine.

Case presentation: A previously healthy 24-year-old female presented with binocular horizontal diplopia 18 days after receiving the first dose of Pfizer COVID-19 vaccine (Comirnaty®). Anti-ganglioside testing revealed positive anti-GQ1b antibodies. Intravenous immunoglobulins were administered, in a dose of 2 g per kg of body weight over 5 days. On a follow-up exam 3 weeks after the treatment, clinical improvement was noted with normal bulbomotor examination.

Conclusion: Patients with acute ophthalmoplegia occurring after COVID-19 vaccination should be screened for the presence of anti-GQ1b antibody. If the antibody is present, intravenous immunoglobulin should be administered as it may hasten clinical improvement.

Keywords: COVID-19; Miller Fisher syndrome; Pfizer vaccine.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • COVID-19 Vaccines
  • COVID-19*
  • Female
  • Gangliosides
  • Humans
  • Miller Fisher Syndrome* / chemically induced
  • Miller Fisher Syndrome* / diagnosis
  • Ophthalmoplegia* / diagnosis
  • SARS-CoV-2
  • Young Adult


  • COVID-19 Vaccines
  • Gangliosides