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Rhino-orbital-cerebral mucormycosis in diabetic ketoacidosis: A classic clinical presentation still unknown in Senegal

Summary

A young woman in Senegal with uncontrolled diabetes developed a serious fungal infection affecting her eye and brain caused by Rhizopus oryzae. Despite showing classic warning signs like swelling and tissue death, the infection was not diagnosed quickly enough, and the necessary antifungal medication (amphotericin B) was not available, resulting in her death within three days. This case highlights how invasive fungal infections are underrecognized and undertreated in Africa due to limited laboratory capacity and drug availability.

Background

Rhino-orbital-cerebral mucormycosis (ROCM) is a rare invasive fungal infection caused by Mucorales fungi that primarily affects immunocompromised patients and those with uncontrolled diabetes. Though ROCM is rapidly progressive and potentially fatal, it remains poorly recognized in sub-Saharan Africa where diagnostic and treatment capabilities are limited.

Objective

This case report documents a fatal case of ROCM caused by Rhizopus oryzae in a 27-year-old woman with diabetic ketoacidosis in Dakar, Senegal, to highlight diagnostic challenges and the need for improved clinical awareness and access to antifungal therapies in sub-Saharan Africa.

Results

A 27-year-old female presented with diabetic ketoacidosis complicated by periorbital cellulitis with rapid progression of necrosis in the right orbitofrontal region. Rhizopus oryzae was identified via fungal culture and MALDI-TOF MS, but the patient died on day 3 of hospitalization before definitive diagnosis and appropriate antifungal therapy could be initiated.

Conclusion

Despite presenting with classic clinical features of ROCM, the patient died due to delayed diagnosis, lack of clinical-mycological collaboration, and unavailability of essential antifungal agents like amphotericin B in Senegal. The case underscores the urgent need for improved training, laboratory capacity, and access to WHO-recommended antifungal medications in sub-Saharan Africa.
  • Published in:IDCases,
  • Study Type:Case Report,
  • Source: PMID: 40475795, DOI: 10.1016/j.idcr.2025.e02244
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