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Rhinocerebral Mucormycosis in a Patient With Diabetes: A Rare but Critical Infection in the United Arab Emirates

Summary

A middle-aged man with undiagnosed diabetes developed a serious fungal infection called mucormycosis that affected his sinuses, eyes, and brain. He presented with flu-like symptoms and facial weakness, and blood tests showed dangerously high blood sugar and acid levels (diabetic ketoacidosis). Doctors treated him with multiple rounds of antifungal medications, several surgeries, and innovative injections directly into and around his eyes and spinal cord, resulting in his successful recovery and discharge.

Background

Rhino-orbito-cerebral mucormycosis (ROCM) is a rare but aggressive fungal infection caused by Mucor species. The disease is associated with risk factors including diabetes mellitus, diabetic ketoacidosis, and immunocompromised states, which are highly prevalent in the United Arab Emirates where diabetes affects 16.3% of the population.

Objective

To present a case of rhinocerebral mucormycosis in a middle-aged patient with undiagnosed diabetes presenting with diabetic ketoacidosis and to highlight the need for multidisciplinary management approaches beyond current guidelines.

Results

The patient presented with diabetic ketoacidosis (pH 6.9, blood glucose 525 mg/dL) and cranial mononeuritis multiplex. Nasal endoscopy and biopsy confirmed Mucor species infection. Treatment with escalating doses of liposomal amphotericin B (5-10 mg/kg IV), isavuconazole, retrobulbar injections, intrathecal injections via lumbar drain, and multiple surgical debridements resulted in clinical improvement and disease stabilization.

Conclusion

Aggressive multidisciplinary management combining medical antifungal therapy with innovative treatment approaches beyond current guidelines, including retrobulbar and intrathecal amphotericin B injections, successfully controlled ROCM and avoided orbital exenteration. The case emphasizes the need for updated guidelines and randomized clinical trials evaluating combination therapies for ROCM management.
  • Published in:Cureus,
  • Study Type:Case Report,
  • Source: 10.7759/cureus.80807; PMID: 40255854
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