Introduction The Miller Fisher syndrome (MFS), considered a variant of Guillan Barré syndrome, is classically considered a monophasic disorder. We report an exceptional case of recurrent MFS and consequent residual disability.

Case A 54-year-old gentleman, presented with a third episode of diplopia, facial weakness, and limb sensory disturbance. There was a history of MFS occurring firstly at an age of 21, from which a full recovery was made, and a second episode occurring at an age of 48 from which only a partial recovery was made, despite intravenous immunoglobulin treatment (IVIG).

Positive anti-GQ1b, and sensory nerve conduction abnormalities were detected in second and third episodes. At the most recent presentation, two courses of IVIG were administered; improvement was reported in sensory symptoms and diplopia, however disabling residual symptoms remain.

Discussion Recurrent episodes of MFS are particularly rare. 37 cases of recurrent MFS have been reported in the literature. As in previously reported recurrences, our case demonstrated a young age of onset, positive anti-GQ1b and variable duration of remission. However there are few reports of recurrence on more than two occasions, and even fewer reports persistent residual symptoms. Our findings further challenge the perception of MFS as a monophasic disorder.