Miller Fisher Syndrome: A Rare Manifestation of Anti-TNF Therapy in a Patient with Ulcerative Colitis

Miller Fisher syndrome (MFS) is a rare neurologic variant of Guillain-Barré syndrome characterized by the clinical triad of ophthalmoplegia, ataxia, and areflexia. While anti-tumor necrosis factor (TNF) therapy is a cornerstone of ulcerative colitis management, associated neurotoxicity is rare but potentially severe. We present a case of a 70-year-old male with severe ulcerative colitis who developed suspected infliximab-induced MFS following induction therapy. Neurological manifestations progressed rapidly and intensive care unit admission with mechanical ventilation. Treatment with intravenous immunoglobulin and surgical source control via complete colectomy led to recovery, highlighting the need for early recognition and prompt management of biologic-associated neurologic complications.Keywords: Miller Fisher Syndrome, Infliximab, Ulcerative Colitis, Anti-TNF, Neurotoxicity