ABSTRACT
About 20% of people with multiple myeloma (MM) produce only light kappa chains which is produced in 80% of cases. This population of MM patients may be missed where the laboratory could not effectively detect free light chains of immunoglobulins as it is the case in most developing countries. Many reports showed that individuals with lambda light chain disease have a three times worse prognosis than kappa light chain disease. It is therefore important to improve awareness on the need to look out for light chain disease and emphasize the usefulness of a well-equipped laboratory that will fully analyze immunoglobulins of suspected multiple myeloma cases. After reviewing the patient, main findings included paraplegia, constipation and incessant vomiting suggestive of amyloidosis, a positive urinary bence jones proteins (BJP), normal biochemical parameters, elevated lambda light chain level and reversed kappa/lambda ratio of <0.01, magnetic resonance immaging (MRI) proven osteolytic lesions restricted to the spine and histology of bone marrow sample from laminectomy, as well as bone marrow aspiration cytology showed abnormal plasmacytosis. This is an unusual and rare presentation of MM in this environment. Free light chain (FLC) identification and quantitation should be carried out in all cases of suspected MM; especially in those with no monoclonal bands on serum protein electrophoresis and or immunofixation.