A Case Report of Acute Leukemia Revealed by White-Centered Retinal Hemorrhages (Roth Spots)

Abstract

Aims: This study report a rare case of acute leukemia revealed by white-centered retinal hemorrhages (Roth spots), emphasizing their diagnostic value in systemic malignancies. Presentation of Case: A 17-year-old male with no significant medical history was admitted for systemic symptoms including fever, weight loss, and a pulmonary infection. Within 24 hours, he developed sudden bilateral visual loss. Ophthalmologic evaluation revealed severely reduced visual acuity (hand motion) in both eyes. Anterior segment examination and intraocular pressure were normal. Fundus examination showed multiple bilateral, white-centered retinal hemorrhages, associated with superficial and deep macular and peripapillary hemorrhages. Fluorescein angiography revealed blocked fluorescence due to the hemorrhages. Laboratory tests demonstrated leukocytosis (32,200/mm³), anemia (Hb 10.7 g/dL), and thrombocytopenia (86,000/mm³). Bone marrow aspiration confirmed the diagnosis of acute leukemia. The patient was referred to a specialized center and received systemic chemotherapy, resulting in complete remission. Discussion: White-centered retinal hemorrhages (Roth spots) are a key ocular sign that can be an early indicator of acute leukemia, warranting prompt systemic evaluation. Conclusion: This case emphasizes the diagnostic value of a thorough ophthalmological examination. White-centered retinal hemorrhages can be a key early sign of acute leukemia, warranting urgent systemic evaluation.