The term "condylomata acuminata" typically refers to anogenital warts. From the similarities between the conjunctival lesions described in this patient and typical genital warts, it is our recommendation to refer to these lesions as conjunctival condylomata acuminata. This diagnostic term connotes a sexually transmitted etiology and should alert the health care provider to look for possible asymptomatic genital warts on the patient or the patient's sexual partner.
Appropriate management requires prompt recognition of these associations. Practitioners should be familiar with these neuro-ophthalmic manifestations because they may present in the course of daily practice.
A 59-year-old woman presented with bilateral corneal crystals (Figure , A). Ocular cystinosis was suspected; however, there were no pathogenic variants in the cystinosin, lysosomal cystine transporter (CTNS) gene. No underlying causative mechanism raising concern for systemic disease was revealed by a kidney biopsy. A positive M spike led to a bone marrow biopsy, which showed 20% plasma cell neoplasm and confirmed a diagnosis of multiple myeloma. A corneal biopsy was performed prior to further organ system evalua-tion, and immunohistochemical staining returned positive results for κ light chains (Figure , B). No other organ systems were involved. The positive corneal biopsy results confirmed the end-organ involvement criteria to qualify for a bone marrow transplant. This case demonstrates ocular involvement being the determining factor to proceed with a bone marrow transplant for a patient with multiple myeloma and shows how bilateral corneal crystalline deposits should prompt immediate investigation for systemic disease.
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