Despite the back pain and the abnormal radiograph, the key to the diagnosis in this case is that the increase in globulin is polyclonal. Polyclonal increases in globulin can occur in cirrhosis, the early stages of HIV infection, and in inflammatory disorders (eg, systemic lupus erythematosus). Both myeloma and MGUS, as indicated by the name, are associated with monoclonal elevations of either serum or urine gamma globulins (or light chains). While this case may seem to illustrate an obvious point, hematologists frequently are asked to see patients with polyclonal gammopathy to evaluate for myeloma.
- Neither myeloma nor MGUS.
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