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  • Title: Miller fisher variant of guillain-barre syndrome requiring a cardiac pacemaker in a patient on tacrolimus after liver transplantation.
    Author: Kaushik P, Cohen AJ, Zuckerman SJ, Vatsavai SR, Pepper JS, Banda VR, Eason JD, Loss GE, Kaushik R.
    Journal: Ann Pharmacother; 2005 Jun; 39(6):1124-7. PubMed ID: 15855240.
    Abstract:
    OBJECTIVE: To report a case of Miller Fisher syndrome (MFS), a variant of Guillain-Barre syndrome (GBS) necessitating the placement of a permanent cardiac pacemaker in a patient on tacrolimus after a cadaveric orthotopic liver transplantation. CASE SUMMARY: A 46-year-old African American male, who had been receiving tacrolimus 4 mg/day orally for the preceding 6 months, developed a Miller Fisher variant of GBS (severe ataxia, ophthalmoplegia, areflexia). He developed symptomatic sinus pauses requiring a cardiac pacemaker. He improved substantially after cessation of tacrolimus and initiation of intravenous immunoglobulin therapy. The patient was not rechallenged with tacrolimus due to the clinical/ethical gravity of this probable adverse effect. DISCUSSION: Although different types of neuropathies have been reported with the use of tacrolimus, to the best of our knowledge, this is the first case report of a Miller Fisher variant of GBS severe enough to cause dysautonomia requiring a cardiac pacemaker associated with the use of this drug. Causality assessment using the Naranjo probability scale revealed the adverse drug event was probable. CONCLUSIONS: Tacrolimus was probably associated with a Miller Fisher variant of GBS necessitating the placement of a permanent cardiac pacemaker in this patient. MFS needs to be considered a potentially life-threatening adverse effect of tacrolimus therapy.
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