We present the case of a 24-year-old man who came to the emergency department with bilateral decreased VA and headache of two days' duration. The patient's personal history included a case of influenza the previous week treated with ibuprofen 600 mg. On examination the VA of the right eye was bulging and the VA of the left eye was 0.05. Pupils were isochoric and normoreactive and biomicroscopy of the anterior pole was normal. Ophthalmoscopy revealed greyish-white confluent lesions in the posterior pole of both eyes affecting the fovea. Suspecting AMPE, fluorescein angiography (FFA) was performed, showing areas of marked hypofluorescence at early times, which became areas of hyperfluorescence at late times. Indocyanine green angiography (ICG) shows areas of hypofluorescence in the choroid corresponding to the placoid lesions that are related to the choroidal hypoperfusion that accompanies this pathology. Optical coherence tomography showed retinal thickening with hyperreflectivity in the outer retinal layers. Oral corticosteroid treatment (prednisone 60 mg) was started and continued for one week.

On the other hand, the patient reported a severe headache that improved with corticosteroid treatment and reappeared when the medication was discontinued. Therefore, given the suspicion of cerebral vasculitis, which is sometimes associated with this condition, a nuclear magnetic resonance angiography (NMRA) was performed, in which no signs of vasculitis were observed.
A histocompatibility study was requested for HLA B-7 and HLA DR2, which was positive.
The patient's visual acuity improved gradually, but at one month's follow-up the patient reported diplopia in distant vision. Examination revealed paralysis of the right sixth cranial nerve, with slight limitation of abduction of the right eye, which was confirmed by the Hess-Lancaster test. An injection of botulinum toxin was made in the medial rectus of the right eye and after a week the diplopia disappeared.
At present the diplopia has disappeared and the VA is 0.7 in the right eye and 0.8 in the left eye. OCT shows a recovery of the foveal architecture, but with an increase in retinal reflectivity in both eyes.