Invasive fungal infections of the sinonasal tract are a rare but known entity in immunocompromised patients. Paecilomyces lilacinus is a nematophagous fungi with septate hyphae that has afflicted humans in multiple forms, causing cutaneous, ocular, and sinonasal infections. Only 4 cases of P lilacinus and 2 cases of Paecilomyces variotii in the sinonasal tract have been reported in the literature. We present a case of invasive fungal rhinitis secondary to P lilacinus infection in an immunocompromised patient. She was managed successfully with a novel treatment: voriconazole and endonasal microdebridement.