Roth spots as the primary presentation of a metastatic solid malignancy

Abstract

### Learning Point for Clinicians This case report highlights a novel presentation of a common disease, specifically a solid malignancy presenting as blurred vision due to Roth spots. It would be interesting to physicians from a variety of medicine specialities as it links oncology with a well-known, but nonetheless, intriguing ophthalmologic finding. A 58-year-old man with hyperlipidemia and alcohol dependence presented with a 2-day history of visual blurring, seeing flashes of light and pain in his eyes associated with headaches. The patient had bi-temporal region tenderness and hepatomegaly, but no fever or murmurs. Digital retinal imaging revealed bilateral intra-retinal hemorrhages and Roth spots (Figure 1a). The patient was anemic, with a hemoglobin of 91 g/l, had leukocytosis with white blood cell count of 17.2 × 109/l (neutrophils 13.2 × 109/l, lymphocytes 2.6 × …