Monoclonal Gammopathy of Undetermined Significance with Three Bands on Serum Protein Electrophoresis: An Atypical Presentation

Monoclonal Gammopathy (MGM) is a group of B-cell disorders characterised by secretion of abnormal monoclonal Immunoglobulin (Ig) that can be detected by presence of M-protein in serum and urine electrophoresis. Monoclonal protein (M-protein) can be best identified by high resolution agarose gel electrophoresis where, it is usually perceived as a discrete band in the γ or β globulin region. Sometimes atypical banding patterns are seen in serum capillary electrophoresis that pose diagnostic dilemmas and may require repeat testing and further confirmation with a diagnostic test. In the present case, A 60-year-old female patient was advised assessment for gammopathies owing to the presence of skeletal lesions and hyperproteinemia clinically. Serum protein capillary electrophoresis revealed an unusual pattern with three prominent bands in the beta/early gamma region, indicative of triclonal gammopathy, although, it was monoclonal in nature which was depicted during confirmatory diagnostic testing. The authors further discuss the multiple aspects that may be attributed as a cause for such peculiar presentations which should be considered to avoid misdiagnosis.