A50-40 Who Has a Fungus? An Interesting Case of Post Influenza Mucormycosis in Undiagnosed Diabetes

Abstract Introduction Mucormycosis is a rare, invasive fungal infection primarily affecting immunocompromised patients or those with poorly controlled diabetes. We present a 54-year-old woman in diabetic ketoacidosis (DKA) who developed severe, progressive respiratory failure secondary to necrotizing mucormycosis, which invaded her vasculature, bronchi, and neurons. Despite first-line management with amphotericin and a right pneumonectomy, the patient clinically deteriorated. Interestingly, this case lacked nasal involvement. Rhino-orbital-cerebral infection is the most common clinical presentation of mucormycosis, but our patient had no nasal involvement. The patient’s undiagnosed diabetes, likely longstanding and untreated, and influenza A infection proved to be the only identifiable underlying risk factors. This case highlights the need for high clinical suspicion for mucormycosis and for early, aggressive management. Case Presentation A 54-year-old female with no known medical history was found obtunded with agonal respirations and markedly elevated blood glucose of 576. She was intubated in the field. Initial laboratory workup revealed severe DKA (pH 6.79, bicarbonate 5, anion gap 27) and leukocytosis (17,500/mm³). Initial CT imaging demonstrated paranasal sinusitis without evidence of necrosis. She was also positive for influenza A. Bronchoscopy performed on hospital day 3 revealed thick secretions and erythematous mucosa. Cultures later grew numerous non-septate fungal hyphae with ribbon-like branching, consistent with Mucorales. ENT evaluation, including nasal endoscopy, showed no necrotic tissue or fungal sinusitis. Infectious Disease initiated Amphotericin B immediately. Despite antifungal therapy and broad-spectrum antibiotics, the patient developed worsening hypoxia and ventilator desynchrony. Repeat CT imaging showed lung parenchymal consolidations, possible parenchymal necrosis, and moderate to large pleural effusion. Cardiothoracic surgery performed a right pneumonectomy, and histopathology demonstrated extensive angioinvasion with fungal infiltration into bronchial nerves, confirming disseminated mucormycosis. Post-operatively, the patient experienced worsening respiratory failure, and the family elected for comfort measures. Discussion This case highlights two unusual features: mucormycosis without classic rhino-orbital involvement and the rarity of CNS dissemination. Although rhino-orbital-cerebral disease predominates in diabetics, pulmonary involvement carries a mortality exceeding 85%, particularly when disseminated. The angio- and neuro-invasion seen in this case underscore the organism’s aggressive pathology and capacity for rapid spread, even in the absence of immunosuppressive therapy. Conclusion Pulmonary mucormycosis should remain a differential diagnosis in patients with DKA and unexplained pulmonary findings, even in the absence of sinus or cutaneous necrosis. Early recognition, multidisciplinary collaboration, and prompt antifungal and surgical management are crucial, though outcomes remain poor once dissemination occurs. This abstract is funded by: None