LAUSR

A 21yearold white man presented with a 3day history of central blurry vision in his right eye in the context of 3 weeks of right frontotemporal headaches and earaches, fevers, and drenching night sweats. No murmurs or neurological deficits were found. He had no relevant medical or valvular disease history, apart from a dental extraction of his right upper molar 7 weeks prior. He had received two courses of oral antibiotics with minimal improvement (clarithromycin for 7 days, and phenoxymethylpenicillin plus metronidazole for the 3 days before presentation). Visual acuity was hand movements in the right eye and 6/5 in the left eye. There was a right relative afferent pupillary defect. The right eye demonstrated anterior chamber cells and a mild vitritis. Fundoscopy of the right eye revealed a striking area of yellow chorioretinal inflammation at the fovea with retinal haemorrhage, disc swelling, arteriovenous nipping along the superior arcade, tortuous dilated vessels, and cotton wool spots superior to the disc (Box 1). The left eye exhibited mild vitritis and a raised disc without any focal chorioretinal lesions. Optical coherence tomography of the right foveal lesion demonstrated full thickness necrosis of the retina (Box 2).