title: A case of Miller Fisher syndrome during preoperative chemotherapy for breast cancer.
abstract: A 53-year-old woman with breast cancer received FEC treatment (5FU: 500 mg/m(2), epirubicin: 100 mg/m(2), and cyclophosphamide: 500 mg/m(2)) every 3 weeks as preoperative chemotherapy. Fifteen days after her third cycle of FEC, she developed a cold. Diplopia occurred 4 days after developing the cold, and progressive paresthesia of the hands and weakness of the limbs occurred. She had ophthalmoplegia, ataxia, and are flexia and was diagnosed with Miller Fisher Syndrome (MFS). The cause of MFS during chemotherapy is believed to be caused by an immunological response to infection, or drug neurotoxicity. In our case, since the patient underwent an antecedent upper respiratory infection in the period of myelosuppression, her MFS was probably induced by the immunoreaction associated with this infection. Our patient underwent intravenous immunoglobulin therapy. After initiation of the treatment, her neurological symptoms improved, then, she received a fourth cycle of FEC and her remaining neurological symptoms did not worsen. Thus, we report a rare case of MFS developed in immunosuppression by chemotherapy and remind physicians of the alarming triad of MFS symptoms.
authors.affiliation: Department of Breast Surgery, Hamamatsu University School of Medicine Shizuoka, Japan.
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Taki
authors.affiliation: Department of Breast Surgery, Hamamatsu University School of Medicine Shizuoka, Japan.
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Ide
authors.affiliation: Department of Pathology, Shizuoka Saiseikai General Hospital Shizuoka, Japan.
authors.forename: Shogo
authors.initials: S
authors.lastname: Tajima
authors.affiliation: Department of Breast Surgery, Hamamatsu University School of Medicine Shizuoka, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Hosokawa
authors.affiliation: Department of Breast Surgery, Hamamatsu University School of Medicine Shizuoka, Japan.
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Matsunuma
authors.affiliation: Department of Neurology, Hamamatsu University School of Medicine Shizuoka, Japan.
authors.forename: Tatsuhiro
authors.initials: T
authors.lastname: Terada
authors.affiliation: Department of Cell Biology and Anatomy, Hamamatsu University School of Medicine Shizuoka, Japan.
authors.forename: Michihiko
authors.initials: M
authors.lastname: Waki
authors.affiliation: Department of Breast Surgery, Hamamatsu University School of Medicine Shizuoka, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ogura
authors.affiliation: Department of Breast Surgery, Hamamatsu University School of Medicine Shizuoka, Japan.
authors.forename: Norihiko
authors.initials: N
authors.lastname: Shiiya
keywords: Chemotherapy; FEC treatment; Miller Fisher syndrome; breast cancer; diplopia; drug neurotoxicity; immunological response; myelosuppression; ophthalmoplegia; upper respiratory infection