Medical history Male patient, 36 years old, referring severe low back pain and refractory to painkillers for 3 months, associated to painful irradiation to the posterolateral region of the right tight. Reports unintentional weight loss of 7kg for the last 4 months. Laboratory tests: hemoglobin: 9.5g/dL; serum creatinine: 3.2mg/dL; total calcium: 14.7mg/dL; ionized calcium: 8.5mg/dL; phosphorus 4.7mg/dL and serum protein electrophoresis: monoclonal proteins of 2.82g/dL and 43.9% β-2 globulin fraction. Image 1: Computed Tomography (CT) of the lumbar spine, median sagittal reconstruction, soft tissue window.Image 2: Computed Tomography (CT) of the lumbar spine, axial plane, L5 level, soft tissue window. Question:Based on the images and the clinical history, which of the following diagnosis is the most likely? Waldenstrom’s macroglobulinemia Primary hyperparathyroidism Metastatic prostate cancer Multiple Myeloma Time is Up! Time's up
