A Case of Multiple Myeloma Presented With Bilateral Corneal Crystalline Deposition

Abstract

Purpose: Multiple myeloma is characterized by the neoplastic proliferation of a single clone of plasma cells. Multiple myeloma rarely involves the eyeball or the orbital tissues. We report a case of multiple myeloma that presented with corneal crystalline depositions in a patient complaining of decreased vision and irritation of both eyes without any systemic symptoms. Case summary: A 63-year-old woman complained of decreased vision and irritation of both eyes that had started suddenly 20 days before. Uncorrected visual acuity was 0.2 in the right eye and 0.3 in the left eye. Best-corrected visual acuity (BCVA) was 0.9 in the right eye and 1.0 in the left eye. Slit lamp examination showed gray-white crystalline depositions on the epithelium, stroma and Descemet membrane of the cornea extensively, except for the limbus. There were no specific findings on intraocular pressure measurement and fundus examination. The patient did not complain of any systemic symptoms. Multiple myeloma was diagnosed by blood examination and bone marrow biopsy. Two months later, the BCVA decreased to 0.3 in both eyes and artificial tears were prescribed to relieve irritation. Conclusions: When irritation and decreased vision occur abruptly even without systemic symptoms, there is a possibility of multiple myeloma. Systemic evaluations are needed in these cases.

A series of 4 cases of distinct keratopathy secondary to dysproteinemia: Immunotactoid keratopathy

“…2 Since then, numerous descriptions of the association with MGUS have been made. [1][2][3][4][5][6][7][8][9] The term immunotactoid keratopathy (ITK) was coined by Garibaldi et al 2 to describe the corneal deposition of IgG κ as tubular, electron-dense, crystalloid deposits with a central lucent core on electron microscopy. This aligns the ophthalmic literature with the renal, which has defined immunotactoid glomerulopathy by similar criteria since its description by Schwartz and Lewis 11 in 1980.…”

“…[1][2][3][4][5][6][7][8][9] MGUS is a benign condition characterized by a monoclonal paraprotein less than 30 g/L, bone marrow plasmacytosis less than 10%, and absence of bony lytic lesions, anemia, hypercalcemia, or renal insufficiency related to the paraprotein. 10 Rarely, corneal disease will be present with highly variable findings, which makes diagnosis challenging.…”

Crystalline Corneal Deposits in Monoclonal Gammopathy: In-Vivo Confocal Microscopy

“…5 Only 1% of monoclonal gammopathy patients show crystal deposits, including a case of a multiple myeloma in a patient from Korea in 2009. 6 Corneal opacities occurring in various layers caused by abnormal protein deposition are the most common features, and these deposits can appear in many shapes when examined under electron microscopy. In most cases, there are no symptoms or minimal foreign body sensations and glare.…”

A Case of Crystalline Keratopathy in Monoclonal Gammopathy of Undetermined Significance (MGUS)

“…Only 1% of monoclonal gammopathy patients show crystal deposits, including a case of a multiple myeloma in a patient from Korea in 2009 [5]. Primary symptoms include corneal crystal deposits and corneal opacity.…”

“…Monoclonal gammopathy-associated crystalline keratopathy was first reported in a multiple myeloma patient by Meesman in 1934 [ 4 ]. Only 1% of monoclonal gammopathy patients show crystal deposits, including a case of a multiple myeloma in a patient from Korea in 2009 [ 5 ]. Primary symptoms include corneal crystal deposits and corneal opacity.…”