ROTH SPOTS IN A CHILD WITH INTRACRANIAL HEMORRHAGE

Abstract

Background: Infective endocarditis (IE) is uncommon in children. It may not be presented with classical signs and symptoms but late complications such as aneurysm, brain abscess and intracranial haemorrhage. Roth spots are classically associated with IE but it is rare to be seen in paediatric patients.  Here we report a rare case of culture negative infective endocarditis with Roth spots in a child who presented with intracranial haemorrhage.

Case Report: A 9-year-old girl with underlying uncorrected Tetralogy of Fallot presented with difficulty of breathing associated with fever, headache and vomiting for 2 days. Upon arrival to casualty, her Glasgow Coma Scale was 4 and she developed multiple episodes of convulsions. Urgent computed tomography (CT) of the brain showed right occipital haemorrhage with intraventricular haemorrhage. She was then proceeded for emergency craniectomy and external ventricular drainage. Postoperatively patient had persistent fever and infective endocarditis was suspected. Hence, bedside echocardiography (ECHO) was carried out and revealed vegetations of tricuspid valve. On ocular examination noted extensive Roth spots in bilateral eye. Blood cultures taken from multiple sites but negative finding. She was treated empirically with antibiotics but her condition continued to deteriorate and patient succumbed to her disease on day 16 of admission.

Conclusion: High index of clinical suspicion of IE should be raised in children who presented with fever and underlying heart disease or new murmurs to prevent further complications and reduce the mortality rate. Ocular assessment can aid in early detection of IE for prompt multidisciplinary treatment.

Keywords: Roth spots, Infective endocarditis, Tetralogy of Fallot, Intracranial Haemorrhage.