Immunotactoid keratopathy: a clinicopathologic case report and a review of reports of corneal involvement in systemic paraproteinemias

Crystalglobulinemia with Fulminant Course with Cylinder-like Bodies on Peripheral Blood Smear

“…Among these, angiitis-like clinical manifestations in patients have been identified as crystalglobulinemia or cryocrystalglobulinemia (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). In addition, patients found to have only crystal phagocytosis, renal crystal lesions, or corneal lesions have been diagnosed with crystal-storing histiocytosis (15), crystal nephropathy (16), and crystalline keratopathy, respectively (17).…”

“…The clinical manifestations of this condition differ depending on the organ in which crystal deposition occurs. Terms such as crystalglobulinemia (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14), crystal-storing histiocytosis (15), crystal nephropathy (16), and crystalline keratopathy (17) have been used. The clinical manifestations of crystalglobulinemia resemble those in patients with vasculitis or sepsis; namely, purpura, neuropathy, and multiple organ failure.…”

Ocular crystal deposition leading to a diagnosis of multiple myeloma: a report of 2 cases and review of the literature

“…ciliary cysts, or immunoglobulin deposition [1,2,3]. More specifically, myeloma can cause crystalline or non-crystalline deposits in the cornea -this finding tends to occur during the late phase of the disease, but may be the initial manifestation of the underlying asymptomatic gammopathy [4,5].…”

“…More specifically, myeloma can cause crystalline or non-crystalline deposits in the cornea -this finding tends to occur during the late phase of the disease, but may be the initial manifestation of the underlying asymptomatic gammopathy [4,5]. Given the rarity of this presentation, these systemically-well patients are often mistakenly diagnosed with primary corneal diseases such as lattice dystrophy, Schnyder's crystalline dystrophy, or cystinosis that cause ocular irritation and mimic myeloma keratopathy [1,6].…”

“…Cases of crystalline keratopathy in multiple myeloma have previously been described in the ophthalmic literature; it is a rare ocular manifestation present in approximately 1% of patients with a monoclonal gammopathy and is associated with a poor prognosis [1,7]. Symptoms may include photophobia, glare, decreased visual acuity, and irritation, all primarily caused by immunoglobulin deposition (crystal) in the corneal epithelium or stroma [7,8].…”