CASE PRESENTATION: A 60-year-old male with a known history of refractory leukemia, treated with multiple chemotherapeutic regimens in the past, presented with sudden-onset right-sided facial swelling and nasal discharge. He denied any visual abnormalities; however, reported a high-grade fever (Tmax 39 C) for the last 24 hours. His last chemotherapy was 3 weeks prior. On presentation he was taking hydroxyurea. In addition, he was on voriconazole for fungal prophylaxis. On examination he was hypotensive (80/55 mm Hg), tachypneic (23/min), tachycardic (132 beats/min) and febrile (38.8 C). Facial examination revealed edema over his right maxillary sinus as well as around the right orbit. Laboratory data showed a leukocyte count of 19.4 with 3% neutrophils. Computed tomographic imaging of the sinuses exhibited necrotic changes involving the right nasal cavity (Fig. 1a) with maxillary fat pad infiltration; concerning for an invasive fungal disease. The patient was started on Amphotericin and taken for emergent debridement. On surgical exploration he was found to have necrotic material within the right maxillary sinus extending into the right nasal cavity. He underwent extensive debridement and packing of the cavity with Amphotericin soaked foam. Histopathologic examination of debrided tissue confirmed IFS with Rhizopus species (Fig. 1b). The patient currently continues to be on Amphotericin for treatment, with ongoing discussions regarding goals of care. In view of his IFS and underlying refractory leukemia, his prognosis remains extremely poor.