Multiple Myeloma with Bi-clonal Gammopathy Presenting with Aggressive Disease: A Case Report

Introduction: Multiple myeloma is a malignant clonal proliferation of immunoglobulin secreting plasma cells in bone marrow. This immunoglobulin produced by neoplastic plasma cells is mostly in the form of a single prominent monoclonal protein. Having two such distinct bands is rarely seen. We present an interesting case with two monoclonal bands on serum protein electrophoresis. Case Report: A middle aged woman presented with skull, vertebral, bilateral femoral lytic lesions. Laboratory investigations revealed elevated serum immunoglobulin G that was both Kappa and lambda light chain restricted on immunofixation electrophoresis (bi­clonal). The presentation was with aggressive disease, the patient did not respond well with conventional chemotherapy regime, requiring upgrading of chemotherapeutic regime. Conclusion: Bi­clonal gammopathy in plasma cell dyscrasia can be a product of clonal evolution, thus can be a marker of poor prognosis.