Non-secretory Multiple Myeloma: A Challenge to Diagnose

Non-secretory multiple myeloma (NSMM) is a rare variant of multiple myeloma with an incidence rate of 1.0% to 5.0% in all MM cases. It is characterized by symptomatic myeloma in the absence of detectable monoclonal immunoglobulin levels on serum or urine electrophoresis. It often poses a diagnostic dilemma due to its need for more evident features. We report such a non-secretory plasma cell myeloma that manifested as nonspecific back pain and a lytic lesion in the lumbar spine MRI. Confirming an accurate diagnosis early was difficult since no monoclonal immunoglobulin was detected on serum or urine electrophoresis. However, based on the bone marrow study, he was eventually diagnosed as having non-secretory multiple myeloma. He is currently being treated with chemotherapy and has already shown improvement. This case report emphasizes the need for early bone marrow studies and light chain assays in diagnosing non-secretory forms of multiple myeloma if the presentation is indicative. This will help to avoid diagnostic delays, which can finally lead to favorable outcomes if properly addressed.