When your cat takes you to the ICU: Miller Fisher/ Guillain-Barré-overlap-syndrome caused by Pasteurella multocida infection resembling wound botulism

Pasteurella multocida can cause serious soft tissue infections and, less commonly, septic arthritis, osteomyelitis, and sepsis especially in immunocompromised hosts. P. multocida can cause meningitis or meningoencephalitis, occasionally with the formation of abscesses, but is rarely the cause of other neurological diseases. Miller Fisher Syndrome (MFS) is a parainfectious autoimmune disorder presenting with ophthalmoplegia, ataxia and areflexia. We present the case of a 59-year-old immunocompetent patient who developed an atypical Miller Fisher/ Guillain-Barré-overlap-syndrome associated with a phlegmon caused by P. multocida, an associated bacteremia and sepsis leading to long intensive care treatment. Initial differential diagnosis was wound botulism. Patient was treated by antibiotics, wound cleansing with VAC pump and intravenous immunoglobulins. With this case we were able to show that a P. multocida infection can trigger atypical Miller Fisher/ Guillain-Barré-overlap-syndrome and that this is an important differential diagnosis of wound botulism.