Preretinal hemorrhages as the presenting sign of subacute bacterial endocarditis

Spectral-domain optical coherence tomography of roth spots

PURPOSE

To describe the retinal findings of subacute bacterial endocarditis, their evolution after treatment, and analysis with spectral-domain optical coherence tomography.

METHODS

Retrospective chart review.

RESULTS

A 21-year-old man presented with the sudden onset of a central scotoma in his left eye because of a sub-internal limiting membrane hemorrhage overlying the left fovea. When examined 2 weeks later, Roth spots were noted in his right eye. The patient was immediately referred to his internist and diagnosed with subacute bacterial endocarditis with cultures positive for Streptococcus viridans. He subsequently underwent aortic valve replacement surgery after 4 weeks of intravenous antibiotic therapy. When examined 4 weeks after valve replacement surgery, there was regression of the Roth spots.

CONCLUSION

The present case demonstrates the importance of a funduscopic examination in the early diagnosis and management of subacute bacterial endocarditis. The analysis of Roth spots with spectral-domain optical coherence tomography suggested that they were septic emboli.