Correspondence

Roth's Spots in Leukemic Retinopathy

N Engl J Med 1995; 332:335February 2, 1995

Article

To the Editor:

Although the term “leukemic infiltrates” accurately describes the pertinent funduscopic findings in retinopathy in leukemia, which are strikingly pictured in the image by Perazella and Magaldi (Oct. 6 issue),1 the legend fails to indicate that the distinctive hemorrhages with white centers are Roth's spots. Classically, Roth's spots have been linked with subacute bacterial endocarditis, but the association is not exclusive, since they occur in diverse conditions including leukemia and anemia.2 Similarly, the pathologic basis of the pale white centers can be focal ischemia, inflammatory infiltrate, a colony of infectious organisms, fibrin and platelets, or an accumulation of neoplastic cells.3

Ironically, the white-centered hemorrhages recognized as Roth's spots by present-day clinicians may differ from the white retinal spots Moritz Roth described in 1872 and attributed to degeneration of the nerve-fiber layer.4 Nevertheless, this dramatic photograph of leukemic retinopathy should underline the fact that the clinical usefulness of Roth's spots is not limited to the diagnosis of subacute bacterial endocarditis.

Frederick E. Lepore, M.D.
Robert Wood Johnson Medical School, New Brunswick, NJ 08903

4 References

1. 1

   Perazella MA, Magaldi J. Retinopathy in leukemia. N Engl J Med 1994;331:922-922
   Full Text | Web of Science | Medline

2. 2

   Significance of fundus signs. In: Cogan DG. Ophthalmic manifestations of systemic vascular disease. Vol. 3 of Major problems in internal medicine. Philadelphia: W.B. Saunders, 1974:52.
   

3. 3

   Kaur B, Taylor D. Fundus hemorrhages in infancy. Surv Ophthalmol 1992;37:1-17
   CrossRef | Web of Science | Medline

4. 4

   Roth M. Ueber Netzhautaffectionen bei Wundfiebern. Dtsch Z Chim 1872;1:471-484
   CrossRef