J Korean Ophthalmol Soc.  2018 Jun;59(6):594-597. 10.3341/jkos.2018.59.6.594.

Roth Spots and Panuveitis in a Patient with Infectious Mononucleosis

• Eom HD
• Yoon JH
• Kim JJ
• Eum SJ
• Park DH
• Shin JP

• KMID: 2413825
• DOI: http://doi.org/10.3341/jkos.2018.59.6.594

Abstract

PURPOSE
To report a case of Roth spots, panuveitis, and infectious mononucleosis in a healthy adult.
CASE SUMMARY
An immunocompetent 30-year-old male visited our clinic complaining of reduced visual acuity and a floating sense in both eyes of 2 days. He had experienced flu-like symptoms including fever, sore throat, myalgia, and malaise for 10 days before visual acuity decreased. His best-corrected visual acuity was 20/25 in both eyes and inflammatory cells were found in both the anterior chambers and the vitreous. Funduscopy revealed multiple retinal hemorrhages and Roth spots in both eyes. We prescribed topical steroid eye drops. A peripheral blood test revealed mild leukocytosis with lymphocytosis (60%) consisted of atypical lymphocyte (7%). Serologic examinations were positive for cytomegalovirus (CMV) immunoglobulin M (IgM) Ab and Epstein-Barr virus IgM Ab. A polymerase chain reaction for blood CMV was positive. The presumptive clinical diagnosis was Roth spots and panuveitis associated with infectious mononucleosis. Three weeks later, no inflammatory cells were apparent in the anterior chamber or vitreous. Best-corrected visual acuity had recovered to 20/20 in both eyes, and the retinal hemorrhage had completely disappeared.
CONCLUSIONS
Roth spots and panuveitis can be present in patients with infectious mononucleosis, which should thus be included in the differential diagnosis of Roth spots.

Keyword

Infectious mononucleosis; Retinal hemorrhage; Roth spots; Uveitis

MeSH Terms

Adult
Anterior Chamber
Cytomegalovirus
Diagnosis
Diagnosis, Differential
Fever
Hematologic Tests
Herpesvirus 4, Human
Humans
Immunoglobulin M
Infectious Mononucleosis*
Leukocytosis
Lymphocytes
Lymphocytosis
Male
Myalgia
Ophthalmic Solutions
Panuveitis*
Pharyngitis
Polymerase Chain Reaction
Retinal Hemorrhage
Uveitis
Visual Acuity
Immunoglobulin M
Ophthalmic Solutions

Figure

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  Figure 1. Fundus photographs at the initial visit. Multiple retinal hemorrhages and Roth spots in the right (A, B) and the left (C) eye.

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  Figure 2. Fluorescein angiographs at the initial visit. Blocked fluorescence (arrows) due to retinal hemorrhage and mild peripheral vascular leakage in the right (A) and the left (B) eye.

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  Figure 3. Fundus photographs after treatment with topical steroid eye drop for 3 weeks. Resolved previous multiple retinal hemorrhages and Roth spots in the right (A-C) and the left (D) eye.

Reference

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