A 45 year female with a background history of recent severe Covid-19 pneumonia, diabetes mellitus for five years, hypertension for one year, and hypothyroidism for six months presented to the tertiary care hospital of northern India with discharge per nose for 20 days. The discharge was clear, colorless, watery, non-blood stained, odorless, and increased on bending the head forward. It was associated with painful swelling over the left cheek with low-grade fever. After 12 days, there was painful, non-itchy swelling of the left eye, which was acute in onset and gradually progressive with redness of the eye and foul-smelling ocular discharge. There was no associated impairment in the sensorium, headache, convulsions, vomiting, yellowish coloration of urine, diminution of vision, or facial weakness. The patient denied an impaired hearing, difficulty in chewing, swallowing, change in voice, nasal regurgitation of liquid, neck pain, limb weakness, paresthesia, and bowel/bladder disturbances. There is no history of rash, joint pain, diarrhea, pain abdomen, or significant weight loss. She had a recent fever, cough, and dyspnoea for 15 days before the nasal discharge. She was diagnosed with Covid-19 pneumonia, for which she required hospitalization. The patient was administered remdesivir, methylprednisolone, short-course dabigatran, regular insulin therapy, and oxygen supplementation. She has been a known diabetic for five years and was on regular oral antidiabetic medication (metformin 1000mg and glimepiride 2 mg daily dosage), hypertensive for one year receiving telmisartan 40 mg daily, and hypothyroidism for six months on thyroxine replacement (regular 75 mcg oral levo-thyroxine). Her general examination revealed a pulse of 88/min, regular, blood pressure 136/70 mm Hg, respiratory rate 17/min, temperature 98.8F, sPO2 97% in room air, presence of pallor, with absent icterus, edema, cyanosis, clubbing, significant lymphadenopathy, thyroid swelling, rash, joint tenderness or generalized swelling. Her local examination showed clear, colorless watery discharge from the left nostril, tenderness in the left frontal, ethmoidal and maxillary sinuses with induration over the left maxillary area. The left eye showed chemosis and conjunctival injection. The neurological examination showed normal higher mental function, normal cranial nerve examination including fundus except that olfaction could not be tested, while there was external ophthalmoplegia in the left eye. The rest of the nervous system examination was unremarkable. Her respiratory, cardiovascular, gastrointestinal, and gynecological examinations were normal. Her investigations showed hemoglobin of 10.7 g/dL, leucocyte count of 14600 cells/cumm, neutrophil 76%,lymphocyte 20%, eosinophil 2%, monocyte2%, platelet count 2.80 lac cells/cumm, microcytic hypochromic picture, bilirubin 0.55 mg/dL, random blood glucose 461 mg/dL aspartate transaminase 28 IU/L, alanine transaminase 27.6 IU/L, alkaline phosphatase 202.9 IU/L, protein 6.80 g/dL, albumin 3.7 g/dL, urea 2.8 mg/dL, creatinine 0.71 mg/dL, C Reactive protein 26.9 mg/L, prothrombin time 20.8, INR 1.23, sodium -134.1 mmol/L, potassium -3 mmol/L, ionic calcium 3.44 mg/dL, Interleukin-6 (3.9 pg/mL), lactate dehydrogenase -586.4 IU/L, HbA1C 11.3% with normal thyroid assay. The serology was negative for HBsAg, Anti HCV, HIV, and COVID-19 RT PCR was non significant. Her cerebrospinal fluid examination was normal, including gram stain, fungal stain, and culture/ sensitivity. The nasal discharge was positive for beta-2 transferrin. Her electrocardiogram and chest X-ray were normal. The urine and blood cultures were sterile. Her computerized tomography of paranasal sinuses showed mucosal thickening in the left maxillary, ethmoidal and frontal sinuses, obliteration of osteomeatal complexes, with a defect in left-sided cribriform plate. The magnetic resonance imaging of paranasal sinus and orbit revealed left maxillary, sphenoid, frontal, and bilateral ethmoidal sinusitis, erosion of left inferior orbital wall with focal erosion of medial wall, involvement of extraconal fat, thickening of inferior rectus, involvement of premaxillary soft tissue and masticatory spaces with focal erosion of cribriform plate with right-sided mastoiditis. Her brain MRI showed focal erosion of the left cribriform plate( Figure-1). Functional endoscopic sinus surgery was done, which showed left-sided greyish-brown crusts with congestion suggesting maxillary sinusitis(Figure 2a). The samples were sent for a routine examination, including fungal stain and culture sensitivity. The histopathological examination of nasal tissue was positive for broad-based aseptate fungal hyphae branching at an acute angle resembling mucormycosis along with moderate lymphoplasmacytic inflammatory infiltrates and extensive necrosis( Figure-2b). She was diagnosed as stage 3 rhino-orbital cerebral mucormycosis (ROCM) and treated with liposomal amphotericin B therapy (daily intravenous and single intra-vitreous injection) for six weeks, followed by oral posaconazole therapy for three months. Euglycaemia was maintained with oral antidiabetic medication. The cerebrospinal fluid rhinorrhea resolved with seven days of amphotericin B and the orbital swelling resolved after 14 days of amphotericin B intra-vitreous injection. The sinusitis resolved over three months clinically and radiologically.