Invasive fungal infections of the paranasal sinuses are medical emergencies in immunocompromised patients. Coinfections caused by Mucorales and Fusarium species are rare and require early clinical suspicion. A 60-year-old male patient, a kidney transplant recipient since 2013, with insulin-dependent diabetes mellitus and chronic immunosuppression, was admitted in November 2024 with facial pain, headache, and right periorbital edema. He reported a 15-day history of sinonasal symptoms and presented with preseptal cellulitis, as well as a nodulopustular lesion on the eyebrow. He also reported previous episodes of hyperosmolar state. Computed tomography of the skull and orbits revealed bilateral maxillary sinus disease with hyperattenuating material, suggestive of fungal infection. The patient underwent bilateral maxillary sinusotomy using a combined Caldwell–Luc approach. Intraoperatively, thick mucopurulent secretion was observed and initially considered a possible fungal ball. The surgical and clinical management strategy was to await complementary diagnostic results before initiating systemic antifungal therapy. Histopathological analysis demonstrated hyphae compatible with Mucorales. Simultaneously, fungal culture isolated Fusarium spp. These distinct findings suggested coinfection by two invasive fungi, a condition recognized in immunocompromised patients. After diagnostic confirmation, treatment with liposomal amphotericin B (7.5 mg/kg/day) was initiated and later switched to isavuconazole, with good clinical and radiological response. The patient is currently completing antifungal therapy, with complete resolution of sinusitis and irregular glycemic control. Coinfection by Mucorales and Fusarium is rare and difficult to manage, particularly in immunosuppressed patients. Differential diagnosis with noninvasive forms (such as fungal ball) may delay treatment initiation and compromise prognosis. Despite the intraoperative macroscopic appearance, the clinical and immunological context required investigation for invasive disease. Accurate etiological definition depends on the integration of histopathological and microbiological examinations. According to international guidelines, therapeutic success in mucormycosis requires early diagnosis, surgical debridement, and specific antifungal therapy. This case highlights the importance of clinical vigilance, rapid laboratory response, and a multidisciplinary approach for successful management of severe opportunistic fungal infections.
Machado et al. (Sun,) studied this question.