Acute subretinal abscess in S. aureus septicaemia: BMJ case
A middle-aged man presented to emergency services with central vision loss in the setting of flu-like illness with fever. A striking subfoveal abscess was observed in the right fundus. Focal acute chorioretinal inflammation was noted in the asymptomatic fellow eye. Staphylococcus aureus septicaemia was subsequently diagnosed.

He presented with undiagnosed HIV infection and latent syphilis. Serial high-definition multimodal retinal imaging showcased resolution of the dome-shaped subretinal abscess following treatment with intravenous flucloxacillin. A chorioretinal scar swiftly replaced the subfoveal abscess. Peripheral right vision and full left vision was retained.

Vision loss due to endogenous endophthalmitis in systemic sepsis is an emergency requiring prompt multidisciplinary care. Sight and life are at risk—thus this is not a diagnosis to miss! Early recognition is paramount to health and in retaining vision.

Learning points
• Prompt diagnosis and aggressive rapid management of endogenous bacterial endophthalmitis is necessary. Life and sight are at risk.

• Ophthalmologist should beware of systemic sepsis. Risk factors should be asked for.

• Extensive examination is essential in identifying source of infection of unknown origin and requires a multidisciplinary approach with good communication between teams.

• Multimodal retinal imaging provides exceptional detail of retinal microstructure and is of merit in mapping antimicrobial treatment response in retinal infection.

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