Mucormycosis is an opportunistic, aggressive, and rapidly progressive fungal infection caused by fungi of the order Mucorales, affecting predominantly immunocompromised individuals. Among the main risk factors, diabetes mellitus stands out, especially when uncontrolled, due to predisposition to fungal proliferation in environments of hyperglycemia and acidosis. The rhino-facial form, frequently associated with tissue necrosis, can invade facial structures, the orbit, and the central nervous system, and is considered a medical emergency. We report the case of a 65-year-old woman with type 2 diabetes mellitus on insulin, hypertension, and asthma, who in December 2024 developed ulceration of the hard palate with purulent discharge and loss of upper teeth. After multiple dental consultations and initially inconclusive biopsies, histopathology performed in April 2025 confirmed the presence of broad, irregular, coenocytic hyphae compatible with mucormycosis. Facial CT showed pansinusitis, bony destruction of the hard palate and sphenoid sinuses, with invasion of the pterygopalatine fossa, without intracranial involvement. She was referred to a tertiary center and started on amphotericin B deoxycholate, later switched to the liposomal formulation due to renal toxicity. During hospitalization, she developed pneumonia and cellulitis of an upper limb, both treated with broad-spectrum antibiotics. She underwent surgical debridement in two stages, with extensive resection of necrotic tissue. Direct mycological examination showed hyaline hyphae, and culture revealed a fast-growing cottony colony suggestive of Rhizopus spp. After six weeks of intravenous antifungal therapy, oral isavuconazole was started. She showed progressive clinical improvement, maintaining hemodynamic stability and renal function, and was discharged in June 2025 with outpatient follow-up in infectious diseases and endocrinology. This case reinforces the importance of early diagnosis and multidisciplinary management of rhino-facial mucormycosis, emphasizing the therapeutic triad of systemic antifungal therapy, aggressive surgical debridement, and strict metabolic control as a cornerstone for successful treatment.
Leonardo et al. (Sun,) studied this question.