Non secreting multiple mieloma

We present the case of a 70-year-old woman with no history of interest who had suffered rib pain of 8 months evolution during the day and night with progressive intensity, accompanied by a weight loss of 8 kg in the previous 4 months. Examination revealed a marked decrease in lumbar mobility with intense pain in the chondrosternal joints and knees upon palpation. Haemogram and biochemical analysis were normal. ESR: 16 mm/1st h. Immunoglobulins: IgG 649 mg/dl (690-1400), IgA 118 mg/ dl (70-370), IgM 32.8 mg/dl (40-240), IgD <23.3 IU/ml (0-100), IgE 29.5 IU/ml (0-100). Total Protein: 7.1 g/dl. Serum protein (%): 61.9 albumin, a1 globulins 4.5, a2 globulins 12.4, b globulins 12.4 and γ globulin 8.8. Immunoelectrophoresis: blood: Kappa chains 180 mg/ dl (200-440), Lambda chains 92.7 mg/dl (110-240); urine: Kappa chains 6.7 mg/dl, Lambda chains <0.39 mg/dl; conservation of the IgG, IgA and IgM precipitation arc, balance of light chains in serum with minimal urinary excretion. A simple X-ray showed osteolytic lesions without sclerotic borders of different sizes and without cortical destruction on femurs (Figure 1), humeri (Figure 2), rib cage, clavicles and skull (Figure 3), and with no uptake upon scintigraphy (Tc99).