Non Secretory Multiple Myeloma With HCV Infection: A Rare Case Entity

Multiple myeloma is a neoplasm of b cell lineage characterized by excessive proliferation of abnormal plasma cells. it is characterized by a clinical pentad of 1) anemia, 2) a monoclonal protein in the serum or the urine or both, 3) bone leisons and or bone pain, 4) hypercalcemia>11.5g/dl and 5) renal insufficiency. non secretory multiple myeloma is a rare variant of the classic form of multiple myeloma and accounts for 1% to 5 % of all cases of multiple myeloma. the clinical presentation and radiographic findings of non-secretory multiple myeloma and multiple myeloma are the same. the diagnosis of multiple myeloma requires the demonstration of monoclonal gammopathy in the serum or urine. in non-secretory multiple myeloma, however no such gammopathy can be demonstrated, making the diagnosis more difficult. we describe a 60 year old woman who initially presented with back pain which when further investigated by complete blood count revealed hemoglobin of 13g/dl, total leukocyte count of 10,890 and platelet count of 1.5 lac/cmm. viral markers revealed hcv positive. hypercalcemia with a serum calcium level of 12.5g/dl was also demonstrated. mri revealed multiple lytic bony lesions. no monoclonal gammopathy was found in the serum or urine and bone marrow biopsy showed marked plasmacytosis of > 45%. we present a case of non secretory multiple myeloma because of its illusive nature and rare entity.