An elderly female presented to the emergency department with a right-sided facial droop and
headache for two weeks. Investigations revealed poorly controlled diabetes, and the patient was found to be in
diabetic ketoacidosis. Maxillofacial computed tomography (CT) demonstrated right postseptal
cellulitis with concern for acute invasive fungal
sinusitis. The patient was taken to the operating room for orbital surgical exploration and antrostomy. Surgical pathology revealed broad hyphae consistent with Rhizomucor species, and the patient was diagnosed with
mucormycosis. Because the patient was not clinically improving, further imaging was obtained, which showed a large right retroantral
phlegmon extending into the cranial fossa and right cavernous sinus, and the patient subsequently underwent surgical
debridement. The following postoperative day, the patient was
stroke-alerted due to altered mental status and inability to follow commands. She was found to have a small embolic
infarct. Due to the poor prognosis of the patient, she was discharged with hospice. Mucormycosis is more commonly found in immunocompromised patients, such as those with uncontrolled
diabetes mellitus but very rarely does it involve the cranium. This disease process is very important to recognize early due to high morbidity and mortality rates and devastating outcomes.