IgM paraprotein and anti-MAG sensory polyneuropathy associated with Waldenstrom’s macroglobulinaemia and medullary carcinoma of the thyroid

A previously fit and well 76-year-old man, presented with distal lower limb sensory symptoms suggestive of peripheral sensory neuropathy, associated with positive anti-MAG antibodies (myelin associated glycoprotein) and IgM paraprotein. Bone marrow biopsy showed lymphoplasmocytoid lymphoma (Waldenstrom’s macroglobulinaemia, WM), consequently positive for MYD88 mutation. He subsequently developed medullary carcinoma of the thyroid, most likely secondary to WM. He underwent a successful total thyroidectomy and four treatment doses of rituximab, which proved beneficial. He is currently stable and under multidisciplinary monitoring. His sensory symptoms have improved following rituximab treatment and his WM is under control.

A Fatal Case of Ciprofloxacin-induced Fulminant Hepatitis

Fatal hepatotoxicity associated with ciprofloxacin is extremely rare. This is the second fully investigated case of fulminant hepatotoxicity due to ciprofloxacin in a male patient previously ciprofloxacin tolerant. The patient’s medical history included stable Waldenstrom’s macroglobulinaemia, inguinal hernia repair, prostate cancer (radiotherapy in 2006) and idiopathic Parkinson’s disease. Extensive investigation for progressive liver failure confirmed drug-induced liver injury.