{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T21:02:36Z","timestamp":1770411756230,"version":"3.49.0"},"reference-count":33,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T00:00:00Z","timestamp":1770336000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Background\/Objectives: Miller\u2013Fisher syndrome (MFS) is a rare Guillain\u2013Barr\u00e9 variant defined by ophthalmoplegia, ataxia, and areflexia. Pediatric MFS is uncommon, and infectious triggers remain underrecognized. Human herpesvirus 6 (HHV-6) is neurotropic but rarely linked to immune-mediated neuropathies. In this paper, we describe a child with MFS associated with HHV-6 detected in cerebrospinal fluid (CSF) and review reported pediatric infections related to MFS. Methods: A 5-year-old girl presented with acute ophthalmoplegia, ataxia, and diminished reflexes. Neuroimaging, ophthalmologic tests, CSF analyses, and serologic andpolymerase chain reaction (PCR) assays were performed, including multiplex reverse transcription\u2013PCR of cerebrospinal fluid using the BioFire\u00ae Meningitis\/Encephalitis panel. A literature search was performed on Pubmed to identify pediatric (0\u201318 years) MFS cases with infectious triggers. Two reviewers independently screened and summarized the literature, and a PRISMA-style flow diagram was used to transparently report the study selection process. Results: HHV-6 DNA was detected via CSF PCR twice, while tests for other pathogens were negative. Anti-GQ1b and related antibodies were negative or borderline. The patient received intravenous immunoglobulin and corticosteroids, with full recovery after one month. Among 20 published pediatric cases (1997\u20132021), Campylobacter jejuni was most frequent, followed by Mycoplasma pneumoniae and influenza viruses. Anti-GQ1b IgM positivity and favorable outcomes were commonly reported, including cases managed conservatively. Conclusions: This case raises the hypothesis that HHV-6 may represent a potential post-infectious association in pediatric MFS. The review findings indicate that pediatric MFS generally follows infection, responds well to immunotherapy, and has an excellent prognosis. Viral testing may be considered in selected, hypothesis-generating contexts in atypical or seronegative pediatric MFS presentations.<\/jats:p>","DOI":"10.3390\/v18020213","type":"journal-article","created":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T10:05:47Z","timestamp":1770372347000},"page":"213","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Human Herpesvirus 6-Associated Miller\u2013Fisher Syndrome in a 5-Year-Old Child: A Case-Based Narrative Review of Pediatric Cases with Infectious Triggers"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3612-4908","authenticated-orcid":false,"given":"Ho-Young","family":"Song","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3243-5853","authenticated-orcid":false,"given":"Kyu Young","family":"Chae","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3613-1075","authenticated-orcid":false,"given":"Sung-Ha","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1038\/nrneurol.2014.138","article-title":"Guillain-Barre and Miller Fisher syndromes\u2014New diagnostic classification","volume":"10","author":"Wakerley","year":"2014","journal-title":"Nat. Rev. Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/S1473-3099(01)00019-6","article-title":"Infectious origins of, and molecular mimicry in, Guillain-Barre and Fisher syndromes","volume":"1","author":"Yuki","year":"2001","journal-title":"Lancet Infect. Dis."},{"key":"ref_3","first-page":"829129","article-title":"Guillain-barre syndrome animal model: The first proof of molecular mimicry in human autoimmune disorder","volume":"2011","author":"Shahrizaila","year":"2011","journal-title":"J. Biomed. Biotechnol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/S0165-5728(98)00072-1","article-title":"Guillain-Barre and Fisher\u2019s syndromes subsequent to Campylobacter jejuni enteritis are associated with HLA-B54 and Cw1 independent of anti-ganglioside antibodies","volume":"88","author":"Koga","year":"1998","journal-title":"J. Neuroimmunol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1736","DOI":"10.1136\/jnnp.2005.065359","article-title":"Ambiguous value of Haemophilus influenzae isolation in Guillain-Barre and Fisher syndromes","volume":"76","author":"Koga","year":"2005","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.jneuroim.2019.01.003","article-title":"Clinical characterization of anti-GQ1b antibody syndrome in Korean children","volume":"330","author":"Yoon","year":"2019","journal-title":"J. Neuroimmunol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1159\/000184748","article-title":"The epidemiology of Guillain-Barre syndrome worldwide. A systematic literature review","volume":"32","author":"McGrogan","year":"2009","journal-title":"Neuroepidemiology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1177\/0883073820988428","article-title":"Miller Fisher Syndrome Triggered by Infections: A Review of the Literature and a Case Report","volume":"36","author":"Ntoulios","year":"2021","journal-title":"J. Child Neurol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.pediatrneurol.2016.06.018","article-title":"Pediatric Miller Fisher Syndrome Complicating an Epstein-Barr Virus Infection","volume":"63","author":"Communal","year":"2016","journal-title":"Pediatr. Neurol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e346","DOI":"10.1097\/WNO.0000000000001079","article-title":"Miller Fisher Syndrome with Papilledema and Antecedent Helicobacter pylori Infection","volume":"41","author":"Wawrzusin","year":"2021","journal-title":"J. Neuroophthalmol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1177\/0883073811420602","article-title":"Miller-Fisher syndrome in association with enterovirus infection","volume":"27","author":"Moustaki","year":"2012","journal-title":"J. Child Neurol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1177\/0883073810382660","article-title":"Miller Fisher syndrome in a toddler with influenza A (pH1N1) infection","volume":"26","author":"Costiniuk","year":"2011","journal-title":"J. Child Neurol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1007\/s10792-017-0529-z","article-title":"A case of atypical ophthalmoplegia after Chikungunya fever","volume":"38","author":"Dutta","year":"2018","journal-title":"Int. Ophthalmol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/j.ejpn.2016.02.002","article-title":"Anti-GQ1b antibody syndrome presenting as acute isolated bilateral ophthalmoplegia: Report on two patients and review of the literature","volume":"20","author":"Guisset","year":"2016","journal-title":"Eur. J. Paediatr. Neurol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1177\/0883073807299969","article-title":"Miller Fisher syndrome and Escherichia coli infection: Is it a novel association?","volume":"22","author":"Blasetti","year":"2007","journal-title":"J. Child Neurol."},{"key":"ref_16","first-page":"317","article-title":"Anti-GQ1b-negative Miller Fisher syndrome presented with one-sided horizontal gaze palsy","volume":"52","author":"Akinci","year":"2010","journal-title":"Turk. J. Pediatr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1002\/mus.25028","article-title":"Bifacial weakness with paresthesias: Serial nerve conduction studies indicate diffuse demyelinating neuropathy","volume":"53","author":"Morgan","year":"2016","journal-title":"Muscle Nerve"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/j.pediatrneurol.2012.04.024","article-title":"Anti-GQ1b-negative Miller Fisher syndrome after Campylobacter jejuni enteritis","volume":"47","author":"Lee","year":"2012","journal-title":"Pediatr. Neurol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1177\/08830738060210061401","article-title":"Bickerstaff brainstem encephalitis associated with Mycoplasma pneumoniae infection","volume":"21","author":"Steer","year":"2006","journal-title":"J. Child Neurol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1017\/S0022215107005889","article-title":"Miller Fisher syndrome: A diagnosis not to be missed","volume":"122","author":"Davis","year":"2008","journal-title":"J. Laryngol. Otol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/S0387-7604(01)00409-0","article-title":"Miller Fisher syndrome with transient coma: Comparison with Bickerstaff brainstem encephalitis","volume":"24","author":"Matsumoto","year":"2002","journal-title":"Brain Dev."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/S0887-8994(01)00281-8","article-title":"Three patients with ophthalmoplegia associated with Campylobacter jejuni","volume":"25","author":"Kuroki","year":"2001","journal-title":"Pediatr. Neurol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/S0887-8994(96)00267-6","article-title":"Cranial polyneuropathy with elevated serum antiganglioside antibody","volume":"16","author":"Matsubara","year":"1997","journal-title":"Pediatr. Neurol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/S0887-8994(01)00362-9","article-title":"Benign intracranial hypertension: Atypical presentation of Miller Fisher syndrome?","volume":"26","author":"Mewasingh","year":"2002","journal-title":"Pediatr. Neurol."},{"key":"ref_25","first-page":"168","article-title":"Miller Fisher syndrome possibly related to mycoplasma pneumoniae infection: Report of one case","volume":"45","author":"Hsueh","year":"2004","journal-title":"Acta Paediatr. Taiwan."},{"key":"ref_26","first-page":"e35656","article-title":"Miller Fisher Syndrome Associated with COVID-19: A Child Case Report and an Up-to-Date Review of the Literature","volume":"15","author":"Poyraz","year":"2023","journal-title":"Cureus"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1111\/j.1600-0404.1992.tb04054.x","article-title":"Newest human herpesvirus (HHV-6) in the Guillain-Barre syndrome and other neurological diseases","volume":"85","author":"Merelli","year":"1992","journal-title":"Acta Neurol. Scand."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1093\/cid\/ciz058","article-title":"Human Herpesvirus 6 Positivity on the FilmArray Meningitis\/Encephalitis Panel Needs Clinical Interpretation","volume":"69","author":"Slenker","year":"2019","journal-title":"Clin. Infect. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Sokolovska, L., Cistjakovs, M., Matroze, A., Murovska, M., and Sultanova, A. (2024). From Viral Infection to Autoimmune Reaction: Exploring the Link between Human Herpesvirus 6 and Autoimmune Diseases. Microorganisms, 12.","DOI":"10.3390\/microorganisms12020362"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.pediatrneurol.2019.10.004","article-title":"HHV-6-Associated Neurological Disease in Children: Epidemiologic, Clinical, Diagnostic, and Treatment Considerations","volume":"105","author":"Eliassen","year":"2020","journal-title":"Pediatr. Neurol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Jang, Y., Choi, J.H., Chae, J.H., Lim, B.C., Kim, S.J., and Jung, J.H. (2020). Pediatric Miller Fisher Syndrome; Characteristic Presentation and Comparison with Adult Miller Fisher Syndrome. J. Clin. Med., 9.","DOI":"10.3390\/jcm9123930"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1016\/j.braindev.2022.07.003","article-title":"Guillain-Barre syndrome in children\u2013High occurrence of Miller Fisher syndrome in East Asian region","volume":"44","author":"Chiu","year":"2022","journal-title":"Brain Dev."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1097\/01.qco.0000168386.16519.93","article-title":"Human herpesviruses-6 and -7 infections","volume":"18","author":"Ward","year":"2005","journal-title":"Curr. Opin. Infect. Dis."}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/18\/2\/213\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T10:12:27Z","timestamp":1770372747000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/18\/2\/213"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,6]]},"references-count":33,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["v18020213"],"URL":"https:\/\/doi.org\/10.3390\/v18020213","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,6]]}}}