A 19-year-old man is evaluated for new-onset Coombs negative hemolytic anemia and elevated transaminases. Slit lamp examination of the cornea is performed. Which additional finding would most strongly support the diagnosis?
- A Golden brown pigment at the limbus sparing the pupillary zone
- B Greenish brown ring at the corneal periphery involving Descemet membrane ✓
- C White circumferential lipid deposit at the corneoscleral junction
- D Branching dendritic ulcer staining with fluorescein
Correct answer: B. Greenish brown ring at the corneal periphery involving Descemet membrane
Explanation
The combination of Coombs negative hemolysis and liver disease in a teenager points to Wilson disease, and the Kayser-Fleischer ring, a greenish brown copper deposition in Descemet membrane at the corneal periphery, is its classic ocular sign. Option A describes iron deposition seen in hemochromatosis. Option C is arcus senilis, a lipid deposit unrelated to copper metabolism. Option D is herpetic keratitis.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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