A 90-year-old man who had a history of transurethral prostate resection for benign prostatic hyperplasia was admitted for left hip pain. A hip radiography examination revealed a large osteolytic lesion in the left greater trochanter, and a bone scintigraphy evaluation showed increased activity in the same area. Because of the patient's history, metastasis from prostate carcinoma was suspected, and bone biopsies were performed the same week. Ten days later, the patient was hospitalized in the emergency department after a fall that fractured the femoral neck. At admission, plasma sodium, chloride, and potassium concentrations were all within their respective reference intervals. The plasma concentration of total protein was 5. 4 showed the presence of an unusual spike in the  region (Fig. 1A). We measured an increased urine concentration of free light chain [1.4 mg/dL (14 mg/L); reference interval, 0 -0.2 mg/dL (0 -2 mg/L)], along with a normal concentration of urine  2 -microglobulin.The patient underwent surgical repair of his left femur. In the meantime, our laboratory asked for serum to complete the investigation of the abnormal UPEP pattern. Investigations of the serum sample revealed a decreased albumin concentration [1.45 g/dL (14.5 g/L); reference interval, 3.0 -4.5 g/dL (30 -45 g/L)]. Immunoglobulin quantification revealed an increased IgG value [2950 mg/dL (29.5 g/L); reference interval, 700 -1000 mg/dL (7-10 g/L)]. IgA and IgM were within their respective reference intervals. Serum protein electrophoresis (SPEP) showed an increased ␣1 region, along with decreased albumin and ␥ regions. Moreover, we found an increased  region (19.1 g/L, quantified from the electrophoresis trace and the total protein concentration), along with a loss of separation between the 1 and 2 regions because of a narrow spike (Fig. 1B). With a normal concentration of -globulins of approximately 300 mg/dL (3 g/L), we estimated the monoclonal protein concentration at approximately 1600 mg/dL (16 g/L). Serum immunofixation was performed with antibodies specific for heavy chains (G, A, M) and light chains (, ). A band was present in the IgG lane with a  electrophoretic mobility, with no corresponding band for the light chain (Fig. 1C). Serum free light chains included a decreased free chain [0.06 mg/dL (0.6 mg/L); reference interval, 0.33-1.94 mg/dL (3.3-19.4 mg/L)], a decreased free