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Paraproteinaemic polyneuropathies are usually chronic and respond poorly to treatment.1 An exception to this is seen in the POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes),2 in which polyneuropathy may improve after treatment for the osteosclerotic myeloma with which it is often associated. Progressive paraproteinaemic neuropathies may also be associated with multiple myeloma, Waldenstrom’s macroglobulinaemia, monoclonal gammopathy of undetermined significance, amyloidosis, and Castleman’s disease.3 Monoclonal gammopathy is often detected in patients with chronic lymphocytic leukaemia,4 but the association between paraproteinaemic polyneuropathy and chronic lymphocytic leukaemia has not previously been reported.
A 73 year old woman with diet controlled diabetes developed, over three days, progressive, bilateral leg weakness without sensory disturbance or sphincter symptoms. Examination disclosed a profound flaccid leg weakness with areflexia and flexor plantar responses. There was a partial right third cranial nerve palsy and poor adduction …