A Case of MGUS with Skeletal Erosion - An Abnormal Presentation

Presented here is a case of 52 years old women who came to emergency with complains of back pain, headache, weight loss and difficulty in walking for 6 months. She had H/O Pulmonary TB for which she took ATT, completed 1 year back. She had no trauma/ recent medical or surgical interventions significant. On CNS examination she features of compressive myelopathy. Her CBC showed, Normocytic-Normochromic anemia with lymphocytic leukocytosis TLC-6500, ESR-raised, CRP-raised and normal PBS. Serum calcium raised and RFT was midly deranged, with normal LFT, R/E and M/E urine. An initial x ray of DL spine and MRI Spine revealed multiple punched out erosions in vertebrae, ilium and femur with few pathological fractures. There was collapse of L2 vertebra without and paradiscal changes or IVDP. An X ray skull showed multiple round punched out bony erosions. Serum free light chain assay revealed kappa chain markedly raised and kappa to lambda ratio highly raised with normal beta chain. Beta 2 microglobulin was greater than 20000 with a normal serum protein electrophoresis. a diagnosis of plasma cell dyscrasia was made. Her immunoglobulin assay was normal, 24 hours Urine protein electrophoresis had band on beta chain and IFE confirmed it kappa paraprotein with normal UPCR and ACR and raised total urinary protein. Bone marrow study was normal. Based on above findings she was diagnosed for monoclonal gammopathy of unknown significance with abnormal bony erosion. Patient was sent to higher center and unfortunately was lost to follow-up.