title: Intraepithelial corneal immunoglobulin crystals in IgG-kappa multiple myeloma.
abstract: A 52-year-old man was first examined because of bilateral superficial punctate keratitis. Slit-lamp examination disclosed numerous intraepithelial minute opacities in both corneas. A corneal biopsy revealed intraepithelial rhomboidal or rectangular crystals that immunohistochemically stained only for IgG-kappa. Serum immunoelectrophoresis demonstrated an IgG-kappa monoclonal gammopathy. Over the ensuing 6 years, the clinical appearance of the crystals changed from small dot-like opacities to polychromatic crystals. At this time, bone marrow examination established the diagnosis of multiple myeloma. Ophthalmologists should be aware of this entity and carefully monitor these patients; the corneal lesions may be the initial manifestation of an asymptomatic monoclonal gammopathy preceding the development of multiple myeloma.
authors.affiliation: Department of Ophthalmology, North Shore University Hospital, Manhasset, New York 11030.
authors.forename: H D
authors.initials: HD
authors.lastname: Perry
authors.forename: E D
authors.initials: ED
authors.lastname: Donnenfeld
authors.forename: R L
authors.initials: RL
authors.lastname: Font
mesh_terms: D003315:Cornea / Q000276:immunology / Q000473:pathology; D003316:Corneal Diseases / Q000276:immunology* / Q000473:pathology; D003318:Corneal Opacity / Q000473:pathology; D006801:Humans; D007122:Immunoelectrophoresis; D007074:Immunoglobulin G / Q000032:analysis*; D007145:Immunoglobulin kappa-Chains / Q000032:analysis*; D007634:Keratitis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis*; D010265:Paraproteinemias / Q000276:immunology* / Q000473:pathology
chemical_list: D007074:Immunoglobulin G; D007145:Immunoglobulin kappa-Chains