A 65-year-old female with a past medical history of diabetes mellitus type II presented to the emergency room with a chief complaint of back pain on the lower back and left hip for the previous 2 months. She denied any fever, weight loss, bleeding, rash, or bruising. Initial laboratory results were remarkable for a normocytic anemia, hyperglycemia, hypercalcemia, and increased alkaline phosphatase. A computed tomography (CT) scan revealed a 3.8-cm lytic lesion in the right proximal to mid femur, a 3.4-cm lytic lesion in the left iliac bone, and multiple small lytic lesions in the bilateral femora. 18F-fluorodeoxyglucose–positron emission tomography (PET)/CT scans noted extensive involvement of the axial and appendicular skeleton and skull base lesions. The patient was referred to the hematology clinic.