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You can't have your cake and eat it too
  1. Simon D J Gibbs1,
  2. Stuart M Williams2,
  3. Xenia Tyler3,
  4. John Pearson4,
  5. Mary Jane Bennie2,
  6. Kristian M Bowles5
  1. 1National Amyloidosis Centre, University College London Medical School, Royal Free Hospital, London, UK
  2. 2Department of Radiology, Norfolk and Norwich University Hospital, Norwich, UK
  3. 3Department of Histopathology, Norfolk and Norwich University Hospital, Norwich, UK
  4. 4Norwich Cytogenetics Service, Norwich, UK
  5. 5Department of Haematology, Norfolk and Norwich University Hospital, Norwich, UK
  1. Correspondence to Dr Simon DJ Gibbs, National Amyloidosis Centre, University College London Medical School, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK; s.gibbs{at}medsch.ucl.ac.uk

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Clinical presentation

A previously well 69-year-old British man presented with a 4-week history of anorexia, weight loss, drenching night sweats, marked lethargy and abdominal pain. Examination revealed pleural effusions and gross ascites. There was no jaundice, fever, cough, signs of chronic liver disease or palpable lymphadenopathy. Investigations revealed a haemoglobin 12.9 g/dl, white cell count 11.3×109/litre, neutrophils 10.4×109/litre, platelets 704×109/litre; creatinine of 107 μmol/l; normal liver enzymes; corrected calcium of 2.23 mmol/l; lactate dehydrogenase 4640 U/l (normal 125–243 U/l); urate 1201 μmol/l (normal <450 μmol/l) and negative HIV serology. CT chest and abdomen (figures 1 and 2) were performed. The patient's poor condition …

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