Dear Editor, A 61-year-old woman was referred to our emergency room because of progressive back pain radiating to chest wall. Recently, she has low-grade fever and body weight loss of 4 kilograms for 2 months. She has had the histories of papillary thyroid carcinoma post thyroidectomy and iodine-131 ablative therapy 20 years ago but without following up for 1 year. Upon admission, her vital signs were stable, and body temperature was 37.8°C. Pertinent physical findings showed numbness below nipple over the trunk region and weakness over bilateral lower extremities with intact anal sphincter tone. There was neither peripheral lymphadenopathy nor hepatosplenomegaly. The complete blood cell counts revealed a white blood cell count of 9.8×10/l, a hemoglobin level of 10.3 g/dl, and a platelet count of 290× 10/l. The biochemistry revealed blood urea nitrogen 25 mg/dl, creatinine 1.1 mg/dl, calcium 10.1 mg/dl (8.1– 10.4 mg/dl), inorganic phosphorus 3.4 mg/dl, alkaline phosphatase 118 u/l, uric acid 6.6 mg/dl, lactate dehydrogenase 839 u/l, total protein 6.4 g/dl, and albumin 4.1 g/dl with an albumin to globulin (A/G) ratio of 2.2 (normal range, 1.2–2.4). Thyroid function profile included a T3 of 40.04 ng/dl (45–132 ng/dl), a thyroid-stimulating hormone of 0.1 mu/l (0.35–6.2 mu/l), a free T4 of 1.53 ng/dl (0.7– 1.8 ng/dl), and a normal thyroglobulin level. Magnetic resonance imaging (MRI) of spine showed a soft-tissue mass in the prespinal and paraspinal regions of the fourth thoracic spine (T4) causing collapse of T4 body. The bone scan of whole body reported an increased uptake on the upper part of T-spine in which metastatic tumor was presumed. She received high-dose methylprednisolone to relieve spinal compression and neurological dysfunction. Then surgical decompression with removal of spinal tumor was performed. Histopathological examination revealed plasmacytoma strongly positive for kappa light chain in tumor cells. The diagnosis of kappa light chain myeloma was affirmed by the examination of bonemarrowwhich showed normocellular marrow infiltrated by 60% of abnormal plasmacytoid cells and which stained positive for kappa light chain. Urine BenceJones protein (BJP) tests showed negative result. Serum protein electrophoresis revealed a hypogammaglobulinemia with immunoglobulin G (IgG), 368 mg/dl (751–1,560 mg/dl), IgA, 37 mg/dl (82–453 mg/dl), IgM, 24 mg/dl (46–304 mg/dl), kappa chain, 522 mg/dl (629–1,350 mg/dl), and lambda chain, 125 mg/dl (313–723 mg/dl). Urine immunoglobulin electrophoresis revealed increased kappa chain level as 668 mg/dl (normal range, 0–1.85 mg/dl). She received oral chemotherapy with mephalan (8 mg/m) plus prednisolone (60 mg/m) for 4 days combined with local radiotherapy over thoracic spines after operation. The activity of bilateral lower extremities got improved after treatment. However, febrile netropenia occurred 3 weeks after chemoradiotherapy. Rapid progressive dyspnea occurred, and chest X-ray showed diffuse interstitial infiltration over bilateral lung fields. She died of Pneumocystis carinii pneumonia (PCP) with acute respiratory distress syndrome (ARDS). Autopsy was not done. Ann Hematol (2008) 87:163–164 DOI 10.1007/s00277-007-0367-6