title: Lupus erythematosus and Miller-Fisher syndrome.
abstract: OBJECTIVE
  To compare the clinical course of an unusual case of Miller-Fisher syndrome in systemic lupus erythematosus with therapeutic interventions, in particular with plasma exchanges.
  
  
  METHODS
  The clinical state and laboratory and electrophysiologic parameters were controlled for over a year and related to therapeutic attempts with immunoglobulins, steroids, and plasma exchanges.
  
  
  METHODS
  Medical intensive care unit of a university hospital.
  
  
  METHODS
  A 17-year-old black female student with known systemic lupus erythematosus who developed ataxia, are flexia, and ophthalmoplegia (Miller-Fisher syndrome) and later became tetraplegic and required full mechanical ventilatory support.
  
  
  RESULTS
  High-dose immunoglobulin treatment combined with corticosteroid pulse therapy was not beneficial. However, plasma exchange (performed five times over a period of 4 months) was followed by a striking clinical improvement within hours after each plasma exchange.
  
  
  CONCLUSIONS
  Plasma exchange appears to remove a yet unknown agent producing a distal motor nerve conduction block and is efficacious in severe neuropathy associated with Miller-Fisher syndrome in lupus erythematosus.
authors.affiliation: Department of Internal Medicine, University Hospital, Zürich, Switzerland.
authors.forename: R
authors.initials: R
authors.lastname: Bingisser
authors.forename: R
authors.initials: R
authors.lastname: Speich
authors.forename: A
authors.initials: A
authors.lastname: Fontana
authors.forename: J
authors.initials: J
authors.lastname: Gmür
authors.forename: B
authors.initials: B
authors.lastname: Vogel
authors.forename: T
authors.initials: T
authors.lastname: Landis
mesh_terms: D000293:Adolescent; D001259:Ataxia / Q000150:complications* / Q000628:therapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000628:therapy; D008775:Methylprednisolone / Q000627:therapeutic use; D009886:Ophthalmoplegia / Q000150:complications* / Q000628:therapy; D010951:Plasma Exchange; D011782:Quadriplegia / Q000150:complications; D012021:Reflex, Abnormal; D013577:Syndrome
chemical_list: D016756:Immunoglobulins, Intravenous; D003520:Cyclophosphamide; D008775:Methylprednisolone