The patient is counselled regarding the presence of  a paraprotein and kept under regular follow up. After 3 years his paraprotein has risen only slightly to 14g and he is briefly lost to follow up due to personal problems.

When he returns to clinic aged 48 he has a number of problems. In particular he complains of swollen ankles and  generalised ‘puffiness’ and is getting dyspnoeic on exertion. He had been drinking to excess after an acrimonious divorce and his GP has attributed a number of his symptoms to alcohol excess.

Question:

What specific symptoms and signs might be found in both a paraprotein-related disorder and liver disease?

#teamhaem for your answers;  the final diagnosis will be revealed and investigations and management discussed midweek. See you on twitter…