Roth Spots in Native Valve Endocarditis

A 48-year-old man presented with a 3-day history of a gray spot within the central vision of his right eye and of retinal hemorrhages. Mitral valve prolapse was reported, and review of systems revealed a 35-pound weight loss, nonproductive cough, and recurrent fevers during the 3 months prior to evaluation. Physical examination revealed corrected visual acuity of 20/20 OU, an auscultated diastolic heart murmur, and an Osler node on the plantar surface of the left foot. Dilated fundus examination findings (pictured) uncovered 2 white-centered retinal hemorrhages (white arrows) along the peripheral superior and inferior arcades of the right eye consistent with the

diagnosis of Roth spots. Blood culture was positive for Streptococcus anginosus, and a transthoracic echocardiogram revealed vegetation with perforation on the posterior leaflet of the mitral valve that was consistent with native valve endocarditis. The patient made full recovery after 4 weeks of systemic treatment with intravenous ceftriaxone (2 g daily) and bioprosthetic mitral valve replacement.

Roth spots are a nonspecific retinal finding and may be found in a variety of other diseases and conditions (eg, diabetes mellitus, anemia, anoxia, leukemia); therefore, a careful systemic evaluation by the physician must be initiated to discover the primary source.^1,2