Roth spots revealing pernicious anemia in a diabetic patient

PurposeTo report a case of pernicious anemia in a patient presenting with white-centered hemorrhages.MethodCase report.ResultsA 64-year-old man with uncontrolled hypertension, insulin-dependent type 2 diabetes, dyslipidemia, and diabetic retinopathy presented with significant bilateral visual acuity reduction. Ophthalmological examination revealed severe diabetic maculopathy, multiple peripapillary Roth spots and hemorrhages. Laboratory tests identified macrocytic anemia with severe vitamin B12 deficiency and an endoscopic biopsy of the gastric fundus led to the diagnosis of pernicious anemia. The patient received blood transfusion, vitamin B12 supplementation and underwent intravitreal anti-VEGF (aflibercept) injections and retinal panphotocoagulation. Over two months, the patient exhibited marked improvement in visual acuity and partial resolution of retinal abnormalities.ConclusionRoth spots are a nonspecific sign that can be found in various pathologies, sometimes severe, such as pernicious anemia. In those cases, adequate vitamin B12 supplementation can resolve the signs and symptoms. Therefore, it is vital to carry out a comprehensive systemic etiological work-up to quickly treat the underlying cause, keeping in mind that multiple pathologies may coexist.