A 56-year-old female presented for follow-up examination for paraproteinemic keratopathy. Seven years prior, she presented with numerous asymptomatic peripheral corneal stromal nummular lesions in both eyes [Fig. 1a-c]. Transforming growth factor, beta-induced (TGFBI) corneal dystrophy genetic tests were negative. She was referred to the Hematology/Oncology service and diagnosed with chronic lymphocytic leukemia (CLL).[1] Despite no obvious crystalline component on clinical examination, using in vivo confocal microscopy we were able to illustrate a crystalline structure to these corneal lesions [Fig. 1d].[2] The patient has remained asymptomatic with best-corrected Snellen visual acuity of 20/20 in each eye.[3] In summary, paraproteinemic keratopathy may be the presenting sign of any systemic disease with paraproteinemia and confocal microscopy may be helpful in the characterization of paraproteinemic keratopathy.[1,4,5]
Figure 1.
(a) Retroillumination slit lamp photo of peripheral corneal nummular stromal lesions. (b) Cross-sectional slit lamp photo highlighting the predominantly anterior stromal location. (c) Anterior segment OCT demonstrating both anterior (top) and posterior (bottom) stromal lesions. (d) In vivo confocal microscopy demonstrating a crystalline morphology of the corneal lesions
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The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
Gerami Seitzman, MD consults for Dompe Pharmaceuticals (not relevant to this article).
References
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