Case 37-2002

Presentation of CaseA 69-year-old man was admitted to the hospital because of painful cutaneous nodules, elevated lipase levels, and abnormal results on abdominal scanning.The patient had been in stable health until 15 weeks earlier, when pain developed in his feet. Two weeks later, articular examination showed firm, nonpitting edema of both ankles and pain on compression of the pedal arches bilaterally. The urine was trace-positive for glucose. The results of laboratory tests are shown in Table 1. The levels of uric acid, total protein, albumin, globulin, aspartate aminotransferase, and alanine aminotransferase were normal. The pattern on serum protein immunoelectrophoresis . . .