Medullary hyperplastic hematopoiesis in thalassemia: Incidental increased Tc-99m sestamibi bone marrow uptake

A 62-year-old, previously healthy white man was referred to our hospital for the recent onset of lumbar pain and the presence in the serum of monoclonal IgG. Clinical workup was planned to ascertain the presence of a clinically relevant monoclonal gammopathy. Tc-99m sestamibi whole-body scintigraphy showed diffusely increased bone marrow uptake. Further laboratory tests were diagnostic for the presence of a beta-thalassemia trait with a concomitant monoclonal gammopathy of undetermined significance. The possibility of concomitant nonmalignant marrow sestamibi uptake must be considered in the clinical assessment of patients with monoclonal gammopathies.