Fungus Ball with Periorbital Abscess in a Patient with Type 2 Diabetes

Fungal infections of the paranasal sinuses, particularly in immunocompromised individuals, pose diagnostic and therapeutic challenges. While fungal balls (mycetomas) are typically noninvasive, their presence in patients with diabetes mellitus warrants careful evaluation due to the potential for coexisting invasive infections. We report the case of a 36-year-old female with poorly controlled type 2 diabetes mellitus who presented with right periorbital cellulitis following cosmetic eyebrow threading. Magnetic resonance imaging revealed right preseptal cellulitis and an incidental finding of a left ethmoid sinus mass. Surgical drainage of the eyelid abscess and functional endoscopic sinus surgery were performed. Histopathology and microbiology confirmed a noninvasive fungal ball caused by Aspergillus species, with no angioinvasion; hence, antifungal therapy was not offered to this patient. The patient was treated with antibiotics targeting Pseudomonas aeruginosa and received intensive insulin management for adequate glucose control. This case underscores the importance of comprehensive imaging and interdisciplinary care in patients with diabetes mellitus with orbital infections. Incidental fungal balls, though often asymptomatic and noninvasive, should be evaluated thoroughly in immunocompromised individuals to exclude invasive disease and ensure appropriate management.