Case History
We present a case of a Caucasian-57-year-old man recently presenting to the Emergency Department (ED) sent by his family doctor referring fever with night sweats, asthenia for mild activities (NYHA III) and itching from one month. Autonomously, the patient performed blood tests that revealed proteinuria (1 g/l) and monoclonal spike in β1 zone on serum electrophoresis. In clinical history referred tooth extractions one month before, hepatitis B, cholecystectomy for gallbladder stones, discectomy for slipped disc, gastroesophageal reflux, rib fractures due to childhood trauma. He referred to smoking and alcohol use for 20 years. In the ED patient’ arterial blood pressure (ABP) was 100/70 mmHg and heart rate was 97 bpm. The remaining vital signs were normal. The physical examination showed excoriation and scratch injuries of the skin in the arms and legs and pitting edema and hyperemia in the legs.