A 42-year-old woman was referred for ophthalmologic evaluation after developing blurry vision in the right eye 30 days prior. She had a history of hyperlipidemia, hypertension, and migraine headaches. Her medications included atorvastatin, carvedilol, and norethindrone. Dilated-fundus examination of the right eye showed a single cotton-wool spot (indicating local retinal ischemia), with intraretinal hemorrhage in the inferotemporal quadrant. Ultrawide-field imaging showed a cotton-wool spot on the left fundus (Figure 1A, right) and a peripheral arterial occlusion in the right eye (Figure 1A, left), and fluorescein angiographic study of the right eye demonstrated an area of blockage corresponding to intraretinal hemorrhage and venous hyperfluorescence (Figure 1B). The patient was afebrile, with pulse 110 beats/min and blood pressure of 188/99 mm Hg. Auscultation over the heart apex revealed a holosystolic ejection murmur (grade 2/6). Laboratory testing showed normal complete blood cell count and thyrotropin level and negative results for autoantibodies against Sm, SSA, SSB, Scl-70, Jo-1, centromere, chromatin, ribonucleoprotein, and antineutrophil cytoplasmic antibodies. Erythrocyte sedimentation rate was mildly elevated (30 mm/h). Results of testing for antinuclear antibodies were positive at low titer (1:40, homogenous pattern) with positive dsDNA (5.0 IU/mL; negative if <4.0 IU/mL). Blood cultures were negative for bacterial or fungal growth after 5 days. An echocardiogram revealed pedunculated and mobile aortic valve vegetations.