A young patient with multiple myeloma.

A 23-year-old female presented with progressive low back pain for several weeks. She had been diagnosed with dermatomyositis at the age of 3 and received corticosteroids episodically for 5 years until her rheumatologic condition achieved complete remission. Magnetic resonance imaging of the spine showed a T2 bright lesion (panel A) at multiple levels without evidence of cord compression. Laboratory findings included normocytic anemia of 9.2 g/dL, normal platelets and white blood cell count, -2 microglobulin of 3.3 mg/L, normal calcium and creatinine. Serum electrophoresis revealed high levels of serum IgG (7970 mg/dL) characterized as IgG monoclonal protein. Urine protein electrophoresis showed 7.6 mg/dL of IgG monoclonal protein. Bone marrow biopsy and aspirate (panel B) showed a hypercellular marrow with 43% infiltration of plasma cells. A diagnosis of IgG multiple myeloma was made and treatment was started with lenalidomide, bortezomib, and dexamethasone. An autologous bone marrow transplantation is planned.