ABSTRACT
A 76-year-old woman presents with a 3- to 4-month history of gradually increasing tiredness and lethargy. She has also noticed numbness and tingling of the hands. On examination she is pale and slightly icteric. A skin rash is noted (Figure 15a). Sensory testing of the legs shows diminished sensation affecting both feet symmetrically. Both ankle jerks are absent and the knee jerks are brisk. Her blood count shows
