Abstract Introduction Pumonary mucormycosis is a rare but often fatal angioinvasive fungal infection, primarily affecting immunocompromised patients, especially those with uncontrolled diabetes and diabetic ketoacidosis (DKA). This case illustrates these challenges and the importance of early diagnosis and multidisciplinary management. Description A 30 year old female presented with nausea and recent pneumonia. She arrived in profound DKA with hyperglycemia (500 mg/dL), severe acidosis, leukocytosis, and electrolyte imbalances. Chest CT showed multifocal cavitary pneumonia and esophageal thickening. Initial treatment included IV fluids, insulin, and broad-spectrum antibiotics. Early in hospitalization, she developed massive hemoptysis requiring ICU admission, intubation, and ventilation. Bronchoscopy revealed extensive clot; cultures grew MSSA and Prevotella. Endoscopy showed severe esophagitis and gastric ulcers. Follow-up imaging revealed worsening cavitary lung disease and pleural effusions. After discharge on oral antibiotics, she was readmitted with fever, neurological deficits, and a cerebellar infarct. Imaging showed a large thrombus from the right inferior pulmonary vein to the left atrium, suggesting embolic stroke. Bronchoalveolar lavage from initial ICU stay later grew Mucorales. Amphotericin B was started, anticoagulation stopped. She developed recurrent hemoptysis, seizures, cerebral air embolism, and progressed to brain death from angioinvasive mucormycosis and CNS involvement. Discussion Pulmonary mucormycosis is frequently diagnosed late due to non-specific findings and slow fungal culture, delaying therapy and surgical options. While amphotericin B remains mainstay treatment, outcomes are poor if diagnosis is delayed. Modern molecular diagnostics (e.g., PCR/mNGS) offer faster, more sensitive detection and could prompt earlier targeted therapy or resection, which has been linked to survival in localized disease. Early infectious diseases and thoracic surgery consultations may facilitate timely antifungal therapy and aggressive surgical intervention. Serial imaging to screen for vascular invasion might prevent catastrophic embolic neurological complications. This abstract is funded by: None
Sharma et al. (Fri,) studied this question.