What are possible causes of highly elevated imm levels with low img levels with no monoclonal gammopathy present?

May not be a problem: This may depend on your genetic background and not be a medical problem. We would need an explanation of your problems, blurred vision, night sweats. Why are you on opiates

Get a consult: A specialist immunologist may be able to address this. I'm concerned right away about a variant of relatively mild immunodeficiency in which there's difficulty switching from IgM to IgG. Rather than trouble you with the details, let me simply suggest that this belongs in the hands of a subspecialist. Best wishes.

Several: Our immune B cells produce IgM fist, then switch to IgG or others by a class-switch process. The defective B cell class-switch can result in high IgM, and low IgG. This could be genetically (hyper IgM syndrome) or viral infection or drugs, or lymphoma, etc.