Conjunctival AL amyloidosis as the initial manifestation of multiple myeloma.
S Melgar Martín, M I Soler Sanchis, L Pérez Zaballos et al.
✦ AI-curated · Sources linked
Case in brief
A 74-year-old man developed raised yellowish-salmon conjunctival plaques during follow-up after cataract surgery. Incisional biopsy showed subepithelial amyloid deposits, Congo red positive, with immunohistochemistry indicating AL amyloidosis and kappa light-chain restriction. Initial systemic evaluation was normal, but subsequent clinical progression led to a diagnosis of multiple myeloma with multisystem involvement. Systemic treatment did not shrink the conjunctival lesions; topical cyclosporine improved ocular discomfort and foreign-body sensation.
What made this case unusual
The conjunctival AL amyloidosis preceded recognition of multiple myeloma, despite an initially normal systemic evaluation.
Diagnostic / clinical pearl
Biopsy with amyloid staining and light-chain characterization can establish the diagnosis in conjunctival plaques; an AL pattern warrants attention to possible systemic disease, even when initial evaluation is unrevealing.
Why it matters
Ocular findings may prompt recognition of systemic disease, supporting multidisciplinary follow-up when conjunctival amyloidosis is identified.