Immunotactoid keratopathy: a clinicopathologic case report and a review of reports of corneal involvement in systemic paraproteinemias.
Corneal deposits in association with paraproteinemias have been well described in the ophthalmic literature. Recent reports in the renal literature have described immunotactoid deposition associated with glomerulopathy-organized microtubular deposits of IgGkappa that measured 32-50 nm in diameter on renal biopsies. We present a case of corneal immunotactoid deposition in the setting of chronic lymphocytic leukemia and review previous reports of corneal deposition in the setting of systemic paraproteinemia, highlighting the etiology, differential diagnosis, prognosis, and treatment of corneal involvement. We propose the use of the term immunotactoid keratopathy to describe corneal IgGkappa deposits appearing as tubular, electron-dense, crystalloid deposits with a central lucent core on electron microscopy and suggest that these patients undergo directed systemic workup to evaluate for potential etiologies of their systemic paraproteinemia. To illustrate the spectrum of paraprotein deposition in the cornea, and to emphasize the importance of ophthalmic evaluation in the setting of systemic paraproteinemias, we include a case of a 44-year-old man with immunoprotein corneal deposition who was subsequently diagnosed with multiple myeloma.
Garibaldi
Daniel C
DC
Eye Pathology Laboratory, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Gottsch
John
J
de la Cruz
Zenaida
Z
Haas
Mark
M
Green
W Richard
WR
D000328:Adult; D003316:Corneal Diseases / Q000209:etiology* / Q000276:immunology / Q000473:pathology; D003941:Diagnostic Techniques, Ophthalmological; D006801:Humans; D007145:Immunoglobulin kappa-Chains / Q000032:analysis; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000209:etiology / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis; D010265:Paraproteinemias / Q000150:complications* / Q000276:immunology / Q000473:pathology
D007145:Immunoglobulin kappa-Chains