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.