Roth’s Stain and Its Relationship to Endocarditis: History and Medical Cases

A preview of the Roth Stain

Many times you can avoid certain symptoms that appear in our body or organism because they seem innocuous and harmless and we decided not to go to the doctor, such as spots, spots, etc.

However, the worst is not this, but when we move from the indifference of a symptom to self-medication, which generates worse ills than the disease itself.

Therefore, we will give you a small example among many that there is, about how a small symptom may be hiding something worse.

The point or spot of Roth

A 42-year-old woman shows up at the Stanford hospital with fevers, chills and mild confusion. A background exam is performed. Which is the diagnosis? It is a point or spot of Roth.

A spot or spot of Roth, most commonly seen in acute bacterial endocarditis, is a red spot (caused by hemorrhage) with a characteristic pale white center. This white center usually represents the plugs of fibrin platelets.

Is it a Roth spot or stain exclusive of bacterial endocarditis?

No. This is a common mistake. A Roth point can be seen in leukemia, diabetes, intracranial hemorrhage, hypertensive retinopathy, subacute bacterial endocarditis and in HIV retinopathy.

What is the story of the name “Point or Spot of Roth”?

“The Roth Spot” or the Roth Spot is derived from Moritz Roth, a Swiss pathologist who described retinal white spots and red spots of the retina in 1872. In the note, he never described the presence of a red dot of the retina combined with the white center point. It was actually described by Mortiz Litten, 6 years later that he would coin the term “Roth Point” that we still use today.

Therefore, some prefer to call this finding a Litten point or a Litten signal. Mortiz Litten was a German doctor known for describing the vitreous bleeding seen in subarachnoid hemorrhage.

Besides, he was the son-in-law of Ludwig Traube, known for the space of Traube and the sign of Traube (systolic sound of a gun fired on the femoral artery in aortic regurgitation).

What is a Koplik stain and why is it mentioned as to the Roth stain?

Koplik spots are seen on measles, usually 1-2 days before the rash appears to extend from head to toe.

Koplik spots are observed in the mucosa of the mouth. Like the spots or the Roth stain, Koplik spots are often described with a pale white center on a red background.

Because of this, we sometimes refer to Roth spots as Koplik spots on the eye (although the cause and pathogenesis of each lesion differs). However, Koplik points are usually many in number and not all injuries have a red background.

What happened to the patient?

He received intravenous Nafcillin at the Stanford hospital and eventually recovered. Barely a day after observing Roth’s stain, he faded markedly and eventually left in days. He recovered completely from endocarditis after a long course of antibiotics.


The fundoscopic examination technique: All physicians must have confidence in the visualization of the retina. The funduscopic examination is the only opportunity you can see the arteries and is an opportunity to help in many diagnoses of the body.

What relationship can you have with Infectious Endocarditis?

To explain this better, let’s review the following medical anecdote that exemplifies better than any explanation to the question. Let’s see…

A 34-year-old man presented to the eye emergency service with reduced vision in the right eye that had developed that morning. It was fine, apart from episodes of dizziness and dyspnea after exercise during the previous 4 months.

These episodes had begun a week after the patient had undergone dental treatment.

The extensive previous investigations had not been conclusive. His retinal appearance and his symptoms motivated the referral to the cardiology team, which admitted him that day.

He was quite feverish but still, he had a pan-christian murmur and a solitary hemorrhage on his right thumb.

Then, it was found that echocardiography revealed moderate to severe mitral regurgitation, with thickening and signs of vegetation. The ejection fraction was 65%. The other values ​​were normal.

Also, it was envisioned that four blood culture series produced Streptococcus viridans, and intravenous antibiotics were started immediately. Her symptoms improved, and her visual acuity gradually improved from 20/200 in the presentation to 20/20 8 months after presentation.

That is to say, Roth spots (retinal hemorrhages centered in a white area) were classically described as septic embolisms lodged in the retina of patients with subacute bacterial endocarditis.

It has also been considered to be nonspecific and can be found in many other diseases. And to be aware of this crossing with other conditions, the treating physician must take into account a review of the histology and pathogenesis of these white haemorrhages, together with the differential diagnosis.