Fatal Rhinocerebral Mucormycosis in a Non-Adherent Diabetic Patient

Abstract

A case was reported involving a 50-year-old woman with poorly controlled diabetes mellitus and a history of medication non-adherence. She initially presented to a peripheral hospital with metabolic acidosis and was treated for diabetic ketoacidosis. However, her condition deteriorated rapidly, necessitating transfer to a multidisciplinary care facility. Upon arrival at the emergency department, a bluish-black rash was observed on the right upper side of her face, which had developed over the preceding 48 hours. The appearance of this rash raised a strong suspicion of invasive fungal infection, specifically mucormycosis.An urgent ENT consultation was obtained, and a smear from the palate revealed the presence of septate hyphae. Intravenous amphotericin was initiated alongside continued management of diabetic ketoacidosis. Surgical intervention involving extensive debridement of the affected skin, with the possibility of enucleation, was advised but declined by the patient’s family. Despite intensive medical management, the patient’s condition progressively worsened, leading to brain death within three days, followed by terminal extubation. This case highlights the severe and often fatal complications of mucormycosis in individuals with uncontrolled diabetes mellitus.