CASE PRESENTATION: A 73-year-old man with a history of AML and prior treatment with azacitidine was admitted to for induction chemotherapy with fludarabine and cytarabine. The patient was on prophylactic antibiotics including acyclovir, ciprofloxacin, and posaconazole. He began having sinus headaches a few days into his admission which did not resolve with loratidine and saline rinses. On chemotherapy day 6, a maxillofacial CT was performed and was concerning for chronic sinusitis and amoxicillin-clavulanate was started. Several days later, MR of the facial sinuses revealed signs of invasive fungal infection. He underwent surgical debridement. On days 10 and 11, mold was isolated from tissue samples obtained during surgery and he was started on Amphotericin-B. Voriconazole was added on day 13 when blood cultures returned positive for Fusarium sp. On day 17, he was scheduled for further debridement, but became febrile, hypotensive, and tachypneic. He was transferred to the intensive care unit with disseminated Fusarium and multiorgan failure. On exam, he was ill appearing, with several small, inflamed, purple plaques 1-3 cm in diameter in various locations on his body. He deteriorated further and was changed to comfort care by family and expired.