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A 90-years-old woman, was referred to our center for dyspnea in January 2022 after testing positive for SARS-CoV-2 infection. The patient completed the COVID 19 vaccination cycle (I and II dose) in October 2021. At the time of hospital admission, chest high resolution computed tomography (HRCT) revealed bilateral ground-glass opacities compatible with interstitial pneumonia. Blood tests revealed abnormal values of lymphocytes (0.7×109/L, r.i. 1.5-4.5), iron (33 μg/ dL, r.i. 50-145) C reactive protein (CRP; 28.1 mg/L, r.v. <5.0) and erythrocyte sedimentation rate (ESR; 79 mm/h, r.v. <37). Two weeks after hospital discharge, an unprecedented alteration of the electrophoretic pattern was found during routine serum protein electrophoresis (SPEP), showing a monoclonal peak in the γ region. The patient had no previous evidence of monoclonal gammopathy on previous exams (SPEP was normal in January 2022). This finding underlines the need to focus more on immune hyperactivation in patients with COVID-19 as well as the prognostic role of these abnormalities for improving patient management. [ABSTRACT FROM AUTHOR]