Description

A 50 year old male with a long history of nonspecific
muscle (myalgia) and joint (arthaligia) pain
was referred to the Rheumatology clinic. He had a
history of alcohol and drug abuse. Prescribed
medications included the anti-inf lammatory drug
Arthotec and dihydrocodeine for pain relief.
Examination revealed no joint abnormalities but
there was evidence of chronic muscle spasm. ESR
was not elevated, full blood count was normal and
his rheumatoid factor (RF) and anti-nuclear
antibodies (ANA) were negative. Routine
biochemistry analysis was performed. Serum
electrolytes, thyroid function, albumin and serum
immunoglobulins were within the reference range.
Serum total protein [77 g/L (reference range 61 – 76
g/L)], urea [9.5 mmol/L (3.4 7.0 mmol/L)] and uric
acid [0.46 mmol/L (0.18 0.42 mmol/L)] were
elevated whilst the activities of serum enzymes ALT
(116 IU/L (1 40 IU/L)) and GGT (72 IU/L
(4 – 35 IU/L)) were increased. Serum electrophoresis
and subsequent densitometry highlighted the
presence of a split albumin peak of equal portions
(Figure 1).