Foveal Micro-embolism in Subacute Bacterial Endocarditis and the Emerging Role of Neutrophil Extracellular Traps: A Case Report and Review of the Literature.

PURPOSE: To report a case of foveal micro-embolism in the setting of subacute bacterial endocarditis following routine dental cleaning.

METHODS

Retrospective case report and literature review.

RESULTS

A 45-year-old man presented with subacute bacterial endocarditis and a small distortion of vision his left eye. Aside from renal, splenic, and brain embolization the patient showed no splinter hemorrhages, Roth spots, Osler's nodes, and Janeway lesions. Further examination demonstrated a discrete, non-hemorrhagic lesion which corresponded to hyperreflective foci disrupting the inner and outer retinal layers on optical coherence tomography. This lesion resolved with observation and intravenous antibiotics.

DISCUSSION: We propose this case represents a distinct embolic mechanism mediated by neutrophil extracellular traps. Recognition of this mechanism may help expand our understanding of the spectrum of embolic phenomena in endocarditis.