Background:Fungal nasal septal abscess is a rare form of invasive fungal rhinosinusitis. Fungal rhinosinusitis in immunocompetent patients tends to be indolent and can present as a fungal ball. In contrast, invasive fungal rhinosinusitis can be destructive and potentially fatal entities requiring emergent surgical intervention. Nasal septal abscess can lead to destruction of the cartilage causing a saddle nose deformity. Case Description:A 76 year old male patient presented with a 4 week history of rhinorrhoea, facial pain and nasal congestion. He had no prior history of any nasal symptoms or surgery. He has a background of Type 2 Diabetes mellitus, rheumatoid arthritis and hypertension. On examination, there was oedematous nasal mucosa, midline septum with congested turbinates bilaterally. CT demonstrated pansinusitis and he was consented for functional endoscopic sinus surgery, septoplasty and turbinoplasty a few weeks later. At time of operation, the patient had a new saddle nose deformity and there was a bulging septum with necrotic cartilage, fungal tissue and pus. Tissue was organised for culture and referred to the infectious disease team for systemic antifungal therapy. Conclusion:Although rare, in immunocompromised patients, fungal nasal septal abscesses can occur in patients with rhinosinusitis. An excellent tissue culture helps guide the treating teams for systemic therapy. References: 1.Cheng LH, Wu PC, Shih CP, Wang HW, Chen HC, Lin YY, Chu YH, Lee JC. Nasal septal abscess: a 10-year retrospective study. Eur Arch Otorhinolaryngol. 2019 Feb;276(2):417-420 2.Huang PH, Chiang YC, Yang TH, Chao PZ, Lee FP. Nasal septal abscess. Otolaryngol Head Neck Surg. 2006 Aug;135(2):335-6