Roth’s Spots a clinical diagnostic clue for Infective Endocarditis

摘要

A 24-year male was admitted to the emergency ward with a history of high-grade fever (103° F) with fatigue and palpitations for 3 months. He had a significant history of congenital heart disease in the form of a ventricular septal defect. He had no history of alcohol consumption or intravenous drug abuse. Cardiac auscultation revealed a harsh holosystolic murmur of grade 3 intensity over the entire precordium. The fundus examination revealed multiple pale-centered retinal hemorrhages suggestive of Roth’s spots (Figure 1A and ​and1B).1B). On transesophageal echocardiography, mobile vegetation (8×4 mm) was seen on the aortic valve. Multiple sets of blood cultures were however sterile. In the presence of a predisposing cardiac risk factor, high-grade fever, the immunological phenomenon of Roth’s spots, and aortic valve vegetation a diagnosis of infective endocarditis was made. The patient was treated with intravenous antibiotics (ceftriaxone, vancomycin, and gentamycin) for infective endocarditis for 6 weeks and improved subsequently. The patient was discharged after the full course of antibiotics and is on outpatient follow up.