INTRAEPITHELIAL CORNEAL IMMUNOGLOBULIN CRYSTALS IN IGG-KAPPA MULTIPLE-MYELOMA

A 52-year-old man was first examined because of bilateral superficial punctate keratitis. Slit-lamp examination disclosed numerous intraepit helial minute opacities in both corneas. A corneal biopsy revealed int raepithelial rhomboidal or rectangular crystals that immunohistochemic ally stained only for IgG-kappa. Serum immunoelectrophoresis demonstra ted an IgG-kappa monoclonal gammopathy. Over the ensuing 6 years, the clinical appearance of the crystals changed from small dot-like opacit ies to polychromatic crystals. At this time, bone marrow examination e stablished the diagnosis of multiple myeloma. Ophthalmologists should be aware of this entity and carefully monitor these patients; the corn eal lesions may be the initial manifestation of an asymptomatic monocl onal gammopathy preceding the development of multiple myeloma.