Roth Spot - 2025 09 12 - Sara Mustafa, DO скачать в хорошем качестве

Roth Spot - 2025 09 12 - Sara Mustafa, DO

This case highlights a 70-year-old woman who presented with poor vision in her left eye after a flu-like illness, with fundus imaging showing flame hemorrhages and central whitening consistent with Roth spots. OCT revealed vitreous debris, outer retinal disruption, and cystic changes, while fluorescein angiography demonstrated scattered areas of hypofluorescence. The differential included hypertensive, diabetic, anemic, and ischemic retinopathies, but Roth spots raised suspicion for subacute bacterial endocarditis. Follow-up confirmed endocarditis with chronic heart failure and septic embolic stroke. The teaching emphasis is on understanding Roth spots: white-centered hemorrhages most classically linked to bacterial endocarditis, though they can also occur with leukemia, anemia, HIV, or systemic hypoxia. While often considered pathognomonic, they are actually present in only about 2% of subacute endocarditis cases. Their appearance reflects fibrin thrombi, platelet aggregates, or bacterial microemboli at sites of vessel rupture. Importantly, Roth spots themselves do not cause symptoms—the underlying systemic disease drives the clinical picture. This case reinforces the need for systemic evaluation when Roth spots are identified, including labs, echocardiography, and infectious work-up. It also stresses broader teaching points: vision changes may be the first clue to life-threatening systemic illness, ophthalmologists can play a critical role in diagnosis, and retinal findings should always be interpreted in the context of systemic risk factors like IV drug use, dental infections, structural heart disease, or immunosuppression