Arboviral infection Dengue can cause a spectrum of disease varying from asymptomatic illness to dengue fever to the severe dengue hemorrhagic fever. Neurological complications are rarely reported in the lit- erature (0.5–6%), mostly from dengue-endemic areas in tropics and subtropical regions. We report a case of a 59-year-old man who returned from a recent work-related travel from India. Three weeks following a mild viral prodrome, he developed bilateral lower motor neuron facial palsy with absent deep tendon reflexes. CSF showed albuminocytologic dissociation and electrophysiological studies showed demyeli- nating neuropathy. Routine GBS screen for common etiological viruses was negative and subsequently additional testing based on recent travel was performed which showed positive Dengue IgM and RNA in serum. The patient was treated with plasma exchange for 5 days and his facial weakness improved to a great extent.This case demonstrates the importance of considering arboviral infections such as Dengue in patients with GBS particularly in people living in or travelling from endemic areas. Additionally, like many other viral illnesses, there may not be clear clinical evidence of Dengue fever and the prodrome may go unnoticed and undiagnosed, hence a high index of suspicion is required.s_hasan_s@yahoo.com

A 74 year old male with a history of plasma cell leukaemia, treated with VMP (bortezomib, melphalan, prednisolone) presented with a 2 week history of lumbar back pain and weakness of the hands and ankles.Clinical examination confirmed asymmetric weakness in the hands and ankles. Sensory examination was initially normal, reflexes preserved and plantars mute. Other than the known IgG paraproteinaemia and longstanding hyponatraemia, bloods, including a vasculitis screen, were unremarkable. MRI brain and spine were non-contributary. CSF examination revealed paired bands consistent with the presence of an IgG paraprotein, but was otherwise bland. Nerve conduction studies showed a severe sensorimotor axonal neuropathy.The patient was treated with plasma exchange followed by IV methylprednisolone but continued to progress developing more proximal weakness and sensory loss to the knees and elbows, with loss of deep tendon reflexes within 2 weeks. Sural nerve biopsy showed axonal degeneration but no vasculitis or malignant infiltration. The patient became increasingly fatigued and cachectic and the decision was made jointly with the haematologists to palliate.Plasma cell leukaemia is a rare and aggressive subtype of multiple myeloma with a poor prognosis which has been associated with malignant nerve infiltration. Bortezomib may also cause a peripheral neuropathy.o.poole@nhs.net