A 56-year-old man presented with a one-year history of progressive weakness predominantly affecting his extremities and persistent low back pain. Ouchterlony immunodiffusion of the concentrated urine detected a marked increase in lambda light chains. A sternal bone marrow documented a diagnosis of multiple myeloma. Screening high resolution agarose gel electrophoresis revealed diffuse hypogammaglobulinemia and, retrospectively, an equivocal, faint band which migrated in the fast gamma region. By using a combination of Immunoelectrophoresis and immunofixation electrophoresis, this questionable band was determined to represent an IgE lambda monoclonal protein. Radioimmunoassay for IgE documented a serum concentration of 50.6 mg/dl. No intact IgE was found in the urine. Following chemotherapy, the patient\u27s serum IgE level decreased significantly, and he is presently asymptomatic. Features of special interest in this case include the low serum IgE level on presentation, which was difficult to detect on the screening electrophoretogram, and the use of immunofixation electrophoresis in the detection and characterization of these difficult gammopathies
