Idiopathic Kyrieleis Plaques with Cotton Wool Spot

This is fundus photograph of the left eye of a 43 year old man who presented with sudden onset of inferior visual field blurring of the left eye. VIsual acuity was 20/20 in each eye. His review of systems was negative. His only medication was a nasal steroid for sinus allergies. Kyrieleis plaques are inflammatory exudates in the walls of arteries (white arrows). He also had one cotton wool spot (black arrow) and one small intraretinal hemorrhage (blue arrow). He had an extensive set of investigations including VDRL, FTA-ABS, ACE, CRP, ESR, CBC, toxoplasma gondii antibody titers, and imaging of his carotid arteries all of which were negative. No treatment was given and his symptoms spontaneously resolved over several months. Possibly he had an inflammatory reaction to an unsuspected viral infection with the periarteriolitis shown in the picture..