This patient with known monoclonal gammopathy presented with bilateral engorged retinal vessels and scattered deep, white-centered retinal hemorrhages. These are most prominent in the temporal periphery.
Learning Points:
The term “Roth spot” was named after Dr. Moritz Roth, who, in 1872, noted white-centered hemorrhages in patients with bacterial endocarditis. He felt that these white spots were septic emboli that originated from an infected cardiac valve.
However, similar lesions can be seen in many other disorders, including leukemia, hyperviscosity, anemia, diabetes, and hypertension. The white material may represent a variety of causes, including fibrin.
So these lesions are best called white-centered hemorrhages, unless one is specifically referring to a lesion in a patient with bacterial endocarditis. See Duane et al Ophthalmology 1980;87;66-69.
