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Multiple myeloma can present with various general symptoms such as fever, fatigue, and night sweats. Bone pain can occur in the pelvic and vertebral bones. However, there are a few reports of abdominal pain as an initial symptom of multiple myeloma. Here, we report the case of a 73-year-old male patient with a chief complaint of acute left lower abdominal pain. The abdominal physical findings were unremarkable. The pain was considered as referred pain, but there was no pain in response to a knock on the back. Further investigation using enhanced abdominal CT revealed a lesion in the left vertebral arch of the 10th thoracic vertebra. Bone marrow biopsy led to a diagnosis of IgA-type multiple myeloma. This case shows that abdominal pain could indicate vertebral lesions, and even without back pain, the condition of the vertebral arches should be investigated., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Yamane et al.)