We report a case of invasive fungal sphenoiditis with nasal septal abscess. We drained the septal abscess and performed endoscopic transnasal sphenoidotomy. The patient suffered from permanent saddle deformity of the nasal dorsum. Bacteriological cultures of the septal abscess fluid revealed Aspergillus flavus. Therapy with voriconazole failed because of resistance of the fungus, however, successful control of the symptoms was finally obtained by therapy with micafungin and itraconazole based on the minimum inhibitory concentration data.
