Roth Spots and Panuveitis in a Patient with Infectious Mononucleosis

Hee Dong Eom; Jung Hyun Yoon; Jong Jin Kim; Sun Jung Eum; Dong Ho Park; Jae Pil Shin

doi:10.3341/jkos.2018.59.6.594

Journal List > J Korean Ophthalmol Soc > v.59(6) > 1096572

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Eom, Yoon, Kim, Eum, Park, and Shin: Roth Spots and Panuveitis in a Patient with Infectious Mononucleosis

Case Report

J Korean Ophthalmol Soc 2018;59(6):594-597.

Published online: 25 September 2018

DOI: https://doi.org/10.3341/jkos.2018.59.6.594

Roth Spots and Panuveitis in a Patient with Infectious Mononucleosis

Hee Dong Eom, MD^1,², Jung Hyun Yoon, MD^1,², Jong Jin Kim, MD^1,², Sun Jung Eum, MD³, Dong Ho Park, MD, PhD^1,², Jae Pil Shin, MD, PhD^1,^2,

¹Department of Ophthalmology, School of Medicine, Kyungpook National University, Daegu, Korea

²Department of Ophthalmology, Kyungpook National University Hospital, Daegu, Korea

³Nune Eye Hospital, Daegu, Korea

Address reprint requests to Jae Pil Shin, MD, PhD Department of Ophthalmology, Kyungpook National University Hospital, #130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea Tel: 82-53-200-5817, Fax: 82-53-426-6552 E-mail: jps11@hanmail.net

Received 8 March 2018 Revised 12 April 2018 Accepted 30 May 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Infectious mononucleosis, Retinal hemorrhage, Roth spots, Uveitis

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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.

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.

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.

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