{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T17:07:45Z","timestamp":1783098465160,"version":"3.54.6"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,10,31]],"date-time":"2022-10-31T00:00:00Z","timestamp":1667174400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,10,31]],"date-time":"2022-10-31T00:00:00Z","timestamp":1667174400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Mucormycosis is a rare, life-threatening fungal infection that affects immunocompromised hosts. Diabetes mellitus is a common predisposing condition and most often presents with rhino-orbital-cerebral infection. Association with coronavirus disease 2019 infection was revealed following a resurgence in cases of mucormycosis during the second wave of the pandemic wherein poorly controlled diabetes mellitus was the most significant risk factor in the affected population. Rhino-orbital-cerebral mucormycosis has a high mortality rate, and cerebral involvement is a poor prognostic factor. Herein, we report a case of newly diagnosed diabetes mellitus with concurrent coronavirus disease 2019 infection complicated by diabetic ketoacidosis and rhinocerebral mucormycosis at presentation, describe the diagnostic and therapeutic challenges, and discuss the interventions that ultimately resulted in a favorable clinical response.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>We describe the case of a previously healthy 13-year-old African American female patient with newly diagnosed diabetes mellitus and concurrent severe acute respiratory syndrome coronavirus 2 infection whose disease course was complicated by rhinocerebral mucormycosis. She presented with fever, altered mental status, and Kussmaul respirations and was diagnosed with diabetic ketoacidosis with concern for cerebral edema. Concern for infectious cerebritis arose due to recurring fevers and persistently altered mental status despite correction of her metabolic derangements. This raised concern for infectious cerebritis and prompted evaluation with serial head imaging, lumbar puncture, and initiation of broad empiric antimicrobial regimen. Head imaging revealed an evolving cerebral abscess, and fungal deoxyribonucleic acid was identified on blood metagenomics testing, which ultimately confirmed the diagnosis of rhinocerebral mucormycosis. Treatment was challenging as she required surgical debridement of the frontal lobe and aggressive antifungal therapy complicated by electrolyte derangements and electrocardiogram changes that necessitated modification of the antimicrobial regimen. Despite these challenges and high mortality rate, the patient was discharged from the hospital in stable condition to inpatient rehabilitation service for reconditioning after prolonged hospitalization.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Rhinocerebral mucormycosis mortality is associated with delays in therapeutic interventions, thus a high index of suspicion and early recognition were essential for timely initiation of antifungal therapy and surgical debridement.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13256-022-03594-2","type":"journal-article","created":{"date-parts":[[2022,10,31]],"date-time":"2022-10-31T16:03:00Z","timestamp":1667232180000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Diabetic ketoacidosis and coronavirus disease 2019-associated mucormycosis: a case report"],"prefix":"10.1186","volume":"16","author":[{"given":"Vanessa","family":"Monroig","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keiko M.","family":"Tarquinio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,10,31]]},"reference":[{"key":"3594_CR1","first-page":"e13163","volume":"13","author":"S Waizel-Haiat","year":"2021","unstructured":"Waizel-Haiat S, Guerrero-Paz JA, Sanchez-Hurtado L, Calleja-Alarcon S, Romero-Gutierrez L. A case of fatal rhino-orbital mucormycosis associated with new onset diabetic ketoacidosis and COVID-19. Cureus. 2021;13:e13163.","journal-title":"Cureus"},{"key":"3594_CR2","unstructured":"Ibrahim BSAS. Chapter 213: Mucormycosis, Harrison\u2019s principles of internal medicine. 20th ed. McGraw-Hill Education; 2018."},{"key":"3594_CR3","doi-asserted-by":"publisher","first-page":"111643","DOI":"10.1016\/j.envres.2021.111643","volume":"201","author":"I Mahalaxmi","year":"2021","unstructured":"Mahalaxmi I, Jayaramayya K, Venkatesan D, et al. Mucormycosis: an opportunistic pathogen during COVID-19. Environ Res. 2021;201:111643.","journal-title":"Environ Res"},{"key":"3594_CR4","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1093\/mmy\/myx101","volume":"56","author":"A Skiada","year":"2018","unstructured":"Skiada A, Lass-Floerl C, Klimko N, Ibrahim A, Roilides E, Petrikkos G. Challenges in the diagnosis and treatment of mucormycosis. 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Epidemiology and pathophysiology of COVID-19-associated mucormycosis: India versus the rest of the world. Mycopathologia. 2021;186:739\u201354.","journal-title":"Mycopathologia"},{"key":"3594_CR8","doi-asserted-by":"publisher","first-page":"102146","DOI":"10.1016\/j.dsx.2021.05.019","volume":"15","author":"AK Singh","year":"2021","unstructured":"Singh AK, Singh R, Joshi SR, Misra A. Mucormycosis in COVID-19: a systematic review of cases reported worldwide and in India. Diabetes Metab Syndr. 2021;15:102146.","journal-title":"Diabetes Metab Syndr"},{"key":"3594_CR9","doi-asserted-by":"publisher","first-page":"1670","DOI":"10.4103\/ijo.IJO_1565_21","volume":"69","author":"M Sen","year":"2021","unstructured":"Sen M, Honavar SG, Bansal R, et al. Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India\u2014Collaborative OPAI-IJO Study on Mucormycosis in COVID-19 (COSMIC), Report 1. Indian J Ophthalmol. 2021;69:1670\u201392.","journal-title":"Indian J Ophthalmol"},{"key":"3594_CR10","doi-asserted-by":"publisher","first-page":"1935","DOI":"10.1111\/dom.14057","volume":"22","author":"J Li","year":"2020","unstructured":"Li J, Wang X, Chen J, Zuo X, Zhang H, Deng A. COVID-19 infection may cause ketosis and ketoacidosis. Diabetes Obes Metab. 2020;22:1935\u201341.","journal-title":"Diabetes Obes Metab"},{"key":"3594_CR11","doi-asserted-by":"publisher","first-page":"2280","DOI":"10.1172\/JCI82744","volume":"126","author":"T Gebremariam","year":"2016","unstructured":"Gebremariam T, Lin L, Liu M, et al. Bicarbonate correction of ketoacidosis alters host-pathogen interactions and alleviates mucormycosis. 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A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"400"}}