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Roth's spots, also known as Litten spots or the Litten sign,<ref name=Stanford2016/> are non-specific red lesions with white or pale centres, seen on the retina of the eye and although traditionally associated with infective endocarditis, can occur in a number of other conditions including hypertension, diabetes mellitus, collagen vascular disease, extreme hypoxia, leukemia and HIV.<ref name=Ruddy2019>Template:Citation</ref><ref name=Blumenthal1999>Template:Cite journal</ref>
Red and white retinal spots were first observed in 1872 by Swiss physician Moritz Roth, and named "Roth spots" six years later by Moritz Litten. They are typically observed via fundoscopy (using an ophthalmoscope to view inside the eye) or slit lamp exam.<ref name=Ruddy2019/><ref name=Blumenthal1999/>
The original retinal spots identified in 1872 were attributed to nerve-fibres that had burst. Present-day analysis shows that they can be composed of coagulated fibrin including platelets, focal ischaemia, inflammatory infiltrate, infectious organisms, or neoplastic cells.<ref name="NEJM">Template:Cite journal</ref>
CauseEdit
Roth's spots occur in conditions that predispose to endothelial damage of retinal capillaries, that is when there is dysfunction and disruption of the endothelium of retinal capillaries. Looking through the microscope reveals lesions with white centers made mainly of fibrin, depicting a fibrin-platelet plug at the site of vessel damage.<ref name=Ruddy2019/>
Associated conditionsEdit
Conditions associated with Roth's spots include:<ref name=Ruddy2019/><ref name=Stanford2016>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
- Infective endocarditis
- Anaemia/thrombocytopenia
- Collagen vascular disease
- Leukemia
- Hypertensive retinopathy
- Diabetic retinopathy
- Pre-eclampsia
- Human Immunodeficiency Virus (HIV)
- Extreme hypoxia
- Shaken-baby syndrome
and also:<ref name=Blumenthal1999/>
- Candida albicans infection
- vascular diseases
- kala azar
PrevalenceEdit
Roth's spots occur in only 5% of people with infective endocarditis.<ref name="Medscape">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Litten, however reported a figure of 80%.<ref name=Ruddy2019/>
See alsoEdit
ReferencesEdit
External linksEdit
- Image from the New England Journal of Medicine: Endocarditis
- Image from the New England Journal of Medicine: CML
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