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.Figure 1.Fundus photographs showing bilateral white-centred haemorrhages.