Abstract Details

Title Serum False Positive Botulism in a Case with Miller Ficher Syndrome

Topic Muscle Disease/Neuromuscular Junction

Presentation(s) P01 - (-)

Poster/Presentation
Number 120

Objective

Background BACKGROUND: Forty three year old female with one week history of chills, and congestion consistent with an upper respiratory tract infection was evaluated. Two days later she was found to have restricted extra ocular movements, decreased abduction of right eye with restricted upward gaze, ptosis of the right eye. She slowly deteriorate with evidence of descending paralysis.

Design/Methods DESIGN/METHODS: We followed patient for 18 days post initial evaluation via daily evaluations and neurological examination. By day six after admission she had complete opthalmoplegia, no longer had antigravity strength in all her extremities, all tendon stretch reflexes were lost, loss of vibration and proprioception. Patient received five day course of IVIG as well as botulinum antitoxin.

Results RESULTS: MRI of brain with contrast did not show any signs of acute pathology. CSF exhibited increased proteins (56), increased nucleated cells (187), and increased granulocytes (73). Electrodiagnostic findings: multiple sensory nerve conduction abnormalities. Anti GQ1b 1:1600. Center for Disease Control report came back serum positive for botulinum toxin type A.

Conclusions CONCLUSIONS: These findings might suggest either a role of the Anti GQ1b antibodies or antibodies found in MFS to be toxic to mouse. Above can also mean similar site of actions of the antibodies or suggest possible cross reactivity of the antibodies with botulinum toxin. If this true than we might be able to imply that there is a possible role of botulinum toxin in treatment or management of MFS or vice versa.

Authors/Disclosures
Yuriy Zeylikman, MD (Novant Health Forsyth Medical Center) PRESENTER	No disclosure on file
Melissa Armstrong, MD, MSc, FAAN, FAAN (UF Department of Neurology)	The institution of Dr. Armstrong has received research support from National Institutes of Health. The institution of Dr. Armstrong has received research support from Florida Department of Health. The institution of Dr. Armstrong has received research support from Lewy Body Dementia Association. The institution of Dr. Armstrong has received research support from The Michael J. Fox Foundation. Dr. Armstrong has received personal compensation in the range of $5,000-$9,999 for serving as a DSMB member with Alzheimer's Clinical Trials Consortium. Dr. Armstrong has received personal compensation in the range of $5,000-$9,999 for serving as a DSMB member with Alzheimer's Disease Cooperative Study. Dr. Armstrong has received personal compensation in the range of $500-$4,999 for serving as a DSMB member with National Institutes of Health. Dr. Armstrong has a non-compensated relationship as a Member, Scientific Advisory Council with Lewy Body Dementia Association that is relevant to AAN interests or activities.
Joseph V. Campellone, MD, FAAN (Cooper University Hospital)	Dr. Campellone has received personal compensation in the range of $5,000-$9,999 for serving as a Content reviewer with VeriMed.
Thomas R. Mirsen, MD	No disclosure on file

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