title: Diagnosis of multiple myeloma in a patient with atypical corneal findings.
abstract: OBJECTIVE
  To report the case of a 67-year-old woman with a diagnosis of multiple myeloma (MM) and atypical corneal opacity as the first appearance.
  
  
  METHODS
  The patient consulted an ophthalmologist regarding blurred vision that progressed gradually without any systemic symptoms. The corneal epithelium and anterior stroma of both eyes harbored diffuse gray-white deposits of unknown etiology. She underwent a general checkup that included molecular genetic analysis. At cataract surgery, performed 5 months after the diagnosis, the corneal epithelium was removed with an epikeratome. The epithelial sheet was analyzed histologically.
  
  
  RESULTS
  Her serum immunoglobulin G (IgG) level was increased; serum immunoelectrophoresis showed a monoclonal gamma-globulin spike of the IgG kappa-type. The presence of 30.4% pleomorphic plasma cells in the bone marrow confirmed the diagnosis of MM. Her visual acuity improved after combined cataract surgery and superficial keratectomy. The surgically removed epithelial sheet showed IgG deposits in the corneal epithelium; electron-dense intracellular deposits were observed in corneal epithelial cells.
  
  
  CONCLUSIONS
  In some individuals, unusual corneal deposits may constitute the first sign of MM. Superficial keratectomy with an epikeratome is a minimally invasive treatment of MM with corneal opacification.
authors.affiliation: Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan. mkojo@ophth.kpu-m.ac.jp
authors.forename: Mina
authors.initials: M
authors.lastname: Nakatsukasa
authors.forename: Chie
authors.initials: C
authors.lastname: Sotozono
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Tanioka
authors.forename: Chihiro
authors.initials: C
authors.lastname: Shimazaki
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kinoshita
mesh_terms: D000368:Aged; D003318:Corneal Opacity / Q000175:diagnosis* / Q000378:metabolism; D019573:Epithelium, Corneal / Q000378:metabolism / Q000648:ultrastructure; D005260:Female; D006801:Humans; D007122:Immunoelectrophoresis; D007074:Immunoglobulin G / Q000097:blood; D007145:Immunoglobulin kappa-Chains / Q000378:metabolism; D046529:Microscopy, Electron, Transmission; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000378:metabolism; D010265:Paraproteinemias / Q000175:diagnosis* / Q000378:metabolism; D014792:Visual Acuity
chemical_list: D007074:Immunoglobulin G; D007145:Immunoglobulin kappa-Chains