Serum immunoglobulin analysis revealed IgA 3430 mg/dl (reference values: 114-457), IgG 204 mg/dl (reference values: 793-1590) and IgM 34.4 mg/dl (reference values: 29-226). Peripheral blood smear showed no abnormalities. Serum protein electrophoresis (SPEP) was positive for a monoclonal spike (M-spike) of 44.2% in the Beta1 region (Figure 4).