Corneal Crystals as an Initiating Factor for a Systemic Bone Marrow Transplant

Abstract

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.

Ocular complications of plasma cell dyscrasias

“…The crystal depositions can mimic corneal findings of ocular cystinosis, but irritation is absent in depositions from myelomatous crystals. 58,75,76 These deposits can involve all layers of the cornea, whereas dystrophies are limited to merely one layer. Patients may be asymptomatic or present with diminished vision, photophobia, and glare.…”