A 60-year-old female had flu-like symptoms from November 1, 2013, and subsequently developed fever, articular pain, retroauricular lymph node swelling, erythema, and dizziness with gait disturbance 4 days later. The patient was admitted to the Department of Internal Medicine at National Defense Medical College Hospital for detailed examination. Nine days after onset, the patient complained of bilateral visual disturbance and was referred to our department. She has a history of current hypertension treated with oral therapy and glaucoma treated with latanoprost eye drops. At the initial ophthalmological examination, best corrected visual acuity was 20/200 in the right eye and 20/50 in the left eye, and intraocular pressure was normal in both eyes. The critical flicker frequency (CFF) was 23 and 27 Hz for the right and left eye, respectively, and a relative afferent pupil defect was noted in the right eye. Slit lamp examination showed fine white keratic precipitates with infiltrating cells in the anterior chamber in both eyes. Funduscopy revealed multifocal retinal ischemic lesions around the macula and posterior pole in both eyes.. Scotoma areas corresponding with the retina lesions were observed by Goldmann visual field test. On SD-OCT, multifocal white retinal lesions were depicted as hyper-reflective regions in the inner retina layers of both eyes, and disruption of ellipsoid line was observed in the left eye. Fluorescein angiography (FA) showed bilateral filling defects corresponding to the retinal lesions, which were surrounded by dye leakage from retinal capillaries. Indocyanine green angiography depicted no abnormalities in both eyes. Brain and orbital MRI were also performed, but the result was not particular. On day 12 after onset of ocular symptoms, aqueous humor sample was collected and tested using multiplex polymerase chain reaction (PCR) for human herpes virus (HHV) 1–8, toxoplasma, toxascaris, bacterial 16srDNA, and fungal 28srDNA, all of which were negative. On the same day, treatment with betamethasone and phenylephrine tropicamide eye drops was initiated. Blood test for coxsackievirus antibody titers revealed that A4, A6, A9, B1, B2, B3, and B5 were positive (titers: 8–32; Table ). An abdominal skin biopsy of necrotic tissue suggested vascular damage caused by coxsackievirus. On the other hand, since the patient fulfilled the diagnostic criteria for polymyalgia rheumatic (PMR), oral corticosteroid (15 mg/day prednisolone) was initiated on November 25, 2013. The general symptoms improved after 6 weeks, and the multifocal retinal ischemic lesions were partially resolved and residual exudates were slightly hard.. However, hyper-reflective regions and disruption of the inner retinal layers on SD-OCT persisted, especially in the right eye. The steroid dose was tapered, and from March 2015, the patient was put under follow-up observation with prednisolone 1 mg/day. After 14 months, the coxsackievirus A4 antibody titer increased by 32-fold. Corrected visual acuity was 20/25 in the right eye and 20/15 in the left eye, and residual paracentral scotoma was observed in the right eye.