To report a case of white-centered retinal hemorrhage in infective endocarditis.

A 45-year-old patient complained of acute visual loss. The patient had a history of epidural anesthesia for the relief of back pain. On the day of admission the patient showed no light perception and had a white-centered retinal hemorrhage and cotton wool spot in the left eye upon fundus examination. Other ocular manifestations were not specific and there were no specific findings on a brain MRI and visual evoked potential. The patient was diagnosed with pyogenic spondylitis and was treated by abscess drainage and systemic antibiotics therapy. The patient's near vision improved up to 0.4/0.5. He was diagnosed with infective endocarditis based on the echocardiogram with epidural and subarachnoid hemorrhage.

Roth spot can occur in many diseases such as diabetes, leukemia, anemia, and trauma, but most commonly in sepsis due to infective endocarditis. Therefore, medical evaluation and an echocardiogram for patients with white-centered retinal hemorrhage should be considered.