Roth Spots As the Initial Manifestation of Accelerated-Phase Chronic Myeloid Leukemia

Roth spots are white-centered retinal hemorrhages associated with various systemic conditions, particularly infective endocarditis and hematologic diseases. We report a case in which Roth spots were the presenting sign of accelerated-phase chronic myeloid leukemia. A 54-year-old man with no significant medical history presented to the ophthalmology emergency department with acute decreased vision in the left eye associated with fever and generalized weakness for four weeks. Fundus examination revealed multiple bilateral white-centered retinal hemorrhages consistent with Roth spots, associated with mild vitreous hemorrhage in the left eye. Laboratory investigations revealed severe anemia, marked leukocytosis, and thrombocytopenia. Peripheral blood smear and bone marrow examination confirmed the diagnosis of accelerated-phase chronic myeloid leukemia. The patient was referred to hematology and started on systemic treatment. This case highlights the importance of fundus examination in detecting systemic hematologic diseases and emphasizes that Roth spots may be the first manifestation of chronic myeloid leukemia.