Abstract: A 63-year-old man with a history of nasopharyngeal carcinoma undergoing oral prednisone therapy presented with headache and acute vision loss. His condition was diagnosed as central retinal artery occlusion. The patient underwent an extensive medical workup, and a temporal artery biopsy was performed to rule out temporal arteritis. Shortly after presentation, the patient developed panuveitis with hypopyon and fundus findings resembling acute retinal necrosis. A diagnostic vitrectomy was performed, a polymerase chain reaction testing was negative for herpes simplex virus, and vitreous cultures grew Aspergillus fumigatus. The patient was treated with intravitreal injection of amphotericin B and oral voriconazole. This is the first report of endogenous Aspergillus endophthalmitis masquerading as temporal arteritis and panuveitis with an acute retinal necrosis–like clinical picture.