Author : LWA Rotty*, H Haroen, P Lasut, C Hendrata, A Pradipta
Non-secretory multiple myeloma is a rare case of hematological malignancies, also a rare variant of multiple myeloma. Several studies have been published, yet the exact mechanism about the absence of M protein still debatable. We described a 61-years-old man with lower back pain due to pathological fracture on fourth lumbar vertebrae, anemia, hypercalcemia, renal impairment, and bone lytic lesion on cranial bone. The absence of M protein in serum protein electrophoresis was a diagnostic dilemma while the patient had all the CRAB manifestations. Serum immunotyping still could not exclude monoclonal gammopathy. We further obtain immunofixation on patients serum and the result shows biclonal gammopathy identified from IgG kappa and IgG lambda paraproteins. This patients diagnosed with non-secretory multiple myeloma and managed with zoledronic acid injection routinely and melphalan prednison (MP) regimen as a definitive treatment modality available here. This case report suggested that non-secretory type of multiple myeloma is a diagnostic challenge for physician with several difficulties include treatment response monitoring due to absence of M protein. Key words: Multiple Myeloma.
Dr. Arend L Mapanawang, Sp.PD, FINASIM, PhD