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Two patients experienced hepatotoxicity associated with erythromycin estolate (Ilosone) usage, followed 13 and 15 years later by an hepatotoxic reaction with administration of erythromycin ethylsuccinate (E.E.S.). These cases provide further evidence for erythromycin ethylsuccinate-associated hepatotoxicity and demonstrate erythromycin cross-sensitivity after previous erythromycin estolate liver injury. Hepatotoxicity to both sensitivity after previous erythromycin estolate liver injury. Hepatotoxicity to both estolate and ethylsuccinate preparations of erythromycin stimulates speculation regarding the potentially hepatotoxic moiety of the erythromycin molecule. Furthermore, these cases suggest that all erythromycin preparations should be avoided or used only with careful monitoring in patients with previous erythromycin-associated liver injury.

Renal tubular acidosis is a relatively rare but well documented disorder of renal acidification in which both the rate and concentration of acid excretion are subnormal during metabolic acidosis. The report of Morris and Fudenberg 1 has called attention to the association of hyperglobulinemic states which defects in urine acidification. In this regard, we have recently studied a patient with inability to acidify the urine, adult Fanconi syndrome, γ-globulinuria, and a primary myopathy. To the best of our knowledge, this combination has not been previously described. Patient Summary A 57-year-old Negro man was admitted to Multnomah Hospital Sept 1, 1966, with a four year history of progressive weakness of his legs. The patient stated that he had difficulty stepping up onto a curb or arising from a kneeling position and, in addition, had shortened his stride because of a subjective impression that he could not adequately support his weight. Two