Case SeriesA series of 4 cases of distinct keratopathy secondary to dysproteinemia: Immunotactoid keratopathy
Section snippets
Case 1
A 66-year-old white male was referred to the cornea service with a history of increased photosensitivity in both eyes over several months, preceded by an episode of redness that self-resolved. He denied fevers, night sweats, weight loss, or fatigue. Medical history was significant for Ménière’s disease, gout, depression, and treated squamous cell carcinoma.
On examination, visual acuity was 6/6 OU. Slit-lamp examination revealed mild nuclear sclerotic cataract in both eyes, and a deep and quiet
Discussion
Meesman first reported the association of bilateral crystalline deposition in the cornea and hypergammaglobulinemia in 1934.2 Since then, numerous descriptions of the association with MGUS have been made.1, 2, 3, 4, 5, 6, 7, 8, 9 The term immunotactoid keratopathy (ITK) was coined by Garibaldi et al.2 to describe the corneal deposition of IgG κ as tubular, electron-dense, crystalloid deposits with a central lucent core on electron microscopy. This aligns the ophthalmic literature with the
Conclusions
The association of ITK with lymphoplasmacytic disorders, particularly MGUS, is well established. Ophthalmologists should familiarize themselves with the Lisch classification to enable the detection of corneal immunoglobulin in its various forms. The observation of an unusual bilateral corneal opacification or corneal protein deposition should prompt the ophthalmologist to raise consideration of this potential malignant association and the need for investigations to detect a monoclonal protein
Disclosure
The authors have no proprietary or commercial interest in any materials discussed in this article.
References (11)
- et al.
Chameleon-like appearance of immunotactoid keratopathy
Cornea
(2012) - et al.
Immunotactoid keratopathy: a clinicopathologic case report and a review of reports of corneal involvement in systemic paraproteinemias
Surv Ophthalmol
(2005) - et al.
Atypical corneal manifestations of multiple myeloma. A clinical, histopathologic, and immunohistochemical report
Cornea
(1989) - et al.
A case of multiple myeloma presented with bilateral corneal crystalline deposition
J Korean Ophthalmol Soc
(2009) - et al.
A case of crystalline keratopathy in monoclonal gammopathy of unknown significance
Korean J Ophthalmol
(2011)
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