IgG Kappa Monoclonal Gammopathy Presenting As Constipation: A Case Report

BACKGROUND Monoclonal gammopathies reflect conditions in which abnormal amounts of immunoglobulins are produced by a clone that developed from a single pro-B germ cell. Monoclonal gammopathies may reflect a disease process, such us multiple myeloma. These diseases may be difficult to diagnose because they affect many tissues and exhibit nonspecific symptoms. OBJECTIVE To present a case of monoclonal gammopathy with constipation as one of the manifestation. CASE ILLUSTRATION A 58 years old male was admitted to the hospital due to constipation and abdominal pain for 10 days, fatigue, weight loss and back pain. Blood test showed anemia, leucopenia, thrombocytopenia, markedly high ESR and hypercalcemia. Serum protein electrophoresis showed monoclonal increased in β 2 globulin and suggestive of monoclonal gammopathy. Blood and urine immunofixation showed monoclonal gammopathy IgG kappa. Magnetic resonance imaging (MRI) of lumbal showed compression fracture of 12th vertebrae thoracal to 5th lumbal vertebrae with bulging disc. Bone mass density showed osteoporosis. Based on the result, patient was suspected to have multiple myeloma, but due to refusal of the patient, further evaluation such as bone marrow biopsy was not done. DISCUSSION Constipation may be overlooked as one of the symptoms of monoclonal gammopathy. Upper lumbar vertebra is linked to large bowel movement, and although the sensoric and motoric examination of the patient is normal, but possibly due to compression fracture and bulging disc in lumbar leads to constipation. CONCLUSION It suggested that on practical basis diagnosis of MG should be considered in elderly patients presenting with colitis.