Roth spots in megaloblastic anemia secondary to cytomegalovirus gastritis

Roth spots (white-centered hemorrhages) in an intravenous drug abuser (IVDA) are classically associated with bacterial endocarditis. They can be seen in other disease states as well. An IVDA with acquired immunodeficiency syndrome (AIDS), decreased vision, and Roth spots observed on funduscopy is described. In this case, the Roth spots were associated with megaloblastic anemia caused by severe cytomegalovirus (CMV) gastritis. Recognition of this entity and prompt treatment of this patient with ganciclovir and B12 injections resolved the anemic state and prevented Further morbidity secondary to CMV infection at 2-year follow-up. The authors want to alert other clinicians to the possibility of treatable anemia in an HIV patient, based on a thorough workup for Roth spots.