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IgM paraprotein and anti-MAG sensory polyneuropathy associated with Waldenstrom’s macroglobulinaemia and medullary carcinoma of the thyroid
  1. Yunfei Yang1 and
  2. Carlo Canepa2
  1. 1Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  2. 2Department of Neurology, James Paget University Hospital NHS Foundation Trust, Great Yarmouth, UK
  1. Correspondence to Dr Yunfei Yang; yunfei.yang{at}


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.

  • thyroid disease
  • haematology (incl blood transfusion)
  • monoclonal gammopathy of undetermined significance associated neuropathy
  • peripheral nerve disease
  • clinical neurophysiology

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  • Contributors CC designed, drafted the first manuscript and is the consultant responsible for the patient. YY revised and synthesised the final manuscript submitted for publishing. Figure 1 is an original image composed by CC. All authors have approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.