This is a 62-year-old male patient who presented with hypertension and history of pain localized in the lumbar region for four months. In addition, he had a pathological fracture of the right third costal arch. He also presented with anemia (10 g/dL), hypercalcemia (11.5 mg/dL), and hyperproteinemia (12.8 g/dL) with an average albumin level (4.1 g/dL), and beta-2-microglobulin of 4 mg/dL.

Further evaluation demonstrated lytic bone lesions in the skull, T12, L4, L5, iliac crest, and acetabulum. Protein electrophoresis and immunofixation revealed a monoclonal IgA kappa paraprotein of 6.6 g/dL (serum-free light chain ratio of 100). A bone marrow aspirate was performed, demonstrating an 88% plasma cells, confirming the diagnosis of multiple myeloma.