“Roth spots in infective endocarditis”

A young male presented with recurrent episodes of fever with chills for 2 weeks.On examination, he was febrile, with tachypnoea and tachycardia.He had a pansystolic murmur at the apex.His fundus examination revealed multiple white centred haemorrhages or 'Roth spots' (Figure 1).On evaluation, an echocardiogram showed a 10 × 12 mm mass attached to the anterior mitral leaflet suggestive of a vegetation.The blood cultures were positive for methicillin-resistant Staphylococcus aureus (MRSA).He was started on ceftriaxone and vancomycin.However, the patient did not respond to the medical management and succumbed after 5 days of ICU stay.Roth spots, or white-centred haemorrhages, were first described by 'Mortiz Roth' in 1872. 1 These are a result of rupture of capillary blood vessels with secondary surrounding fibrin and platelet accumulation. 2These are not septic emboli but are a consequence of increased tendency of the retinal capillaries to bleed.There are multiple causes of 'Roth spot', including severe anaemia, leukaemias, anoxia, disseminated intravascular coagulation, carbon monoxide poisoning and eclampsia.