{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T23:35:25Z","timestamp":1777419325991,"version":"3.51.4"},"reference-count":15,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2005,6,1]],"date-time":"2005-06-01T00:00:00Z","timestamp":1117584000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Ann Pharmacother"],"published-print":{"date-parts":[[2005,6]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE:<\/jats:title>\n                    <jats:p>To report a case of Miller Fisher syndrome (MFS), a variant of Guillain\u2014Barr\u00e9 syndrome (GBS) necessitating the placement of a permanent cardiac pacemaker in a patient on tacrolimus after a cadaveric orthotopic liver transplantation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CASE SUMMARY:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DISCUSSION:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1345\/aph.1e676","type":"journal-article","created":{"date-parts":[[2005,4,26]],"date-time":"2005-04-26T23:08:59Z","timestamp":1114556939000},"page":"1124-1127","source":"Crossref","is-referenced-by-count":14,"title":["Miller Fisher Variant of Guillain\u2014Barr\u00e9 Syndrome Requiring a Cardiac Pacemaker in a Patient on Tacrolimus after Liver Transplantation"],"prefix":"10.1177","volume":"39","author":[{"given":"Prashant","family":"Kaushik","sequence":"first","affiliation":[{"name":"Prashant Kaushik MD, Staff Physician, Hospital Medicine Group, Department of Internal Medicine, Baton Rouge General Medical Center, Baton Rouge, LA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ari J","family":"Cohen","sequence":"additional","affiliation":[{"name":"Ari J Cohen MD, Staff Physician, Section of Abdominal Transplantation, Ochsner Clinic Foundation, New Orleans, LA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven J","family":"Zuckerman","sequence":"additional","affiliation":[{"name":"Steven J Zuckerman MD, Director, Neurology Service, Baton Rouge General Medical Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sundararama R","family":"Vatsavai","sequence":"additional","affiliation":[{"name":"Sundararama R Vatsavai MD, Staff Physician, Hospital Medicine Group, Baton Rouge General Medical Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeremy S","family":"Pepper","sequence":"additional","affiliation":[{"name":"Jeremy S Pepper MD, Resident, Emergency Medicine Residency Program, Louisiana State University, Baton Rouge"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Venkatramana R","family":"Banda","sequence":"additional","affiliation":[{"name":"Venkatramana R Banda MD, Staff Physician, Hospital Medicine Group, Baton Rouge General Medical Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James D","family":"Eason","sequence":"additional","affiliation":[{"name":"James D Eason MD, Chairman, Section of Abdominal Transplantation, Ochsner Clinic Foundation"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"Jr","given":"George E","family":"Loss","sequence":"additional","affiliation":[{"name":"George E Loss Jr MD, Staff Physician, Section of Abdominal Transplantation, Ochsner Clinic Foundation"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richa","family":"Kaushik","sequence":"additional","affiliation":[{"name":"Richa Kaushik MD, Clinical Associate, Hospital Medicine Group, Baton Rouge General Medical Center"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2005,6,1]]},"reference":[{"key":"bibr1-aph.1E676","first-page":"3175","volume":"23","author":"Eidelman BH","year":"1991","journal-title":"Transplant 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