Diagnosis of multiple myeloma in a patient with atypical corneal findings.
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.
Nakatsukasa
Mina
M
Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan. mkojo@ophth.kpu-m.ac.jp
Sotozono
Chie
C
Tanioka
Hidetoshi
H
Shimazaki
Chihiro
C
Kinoshita
Shigeru
S
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
D007074:Immunoglobulin G; D007145:Immunoglobulin kappa-Chains