Rapid-onset respiratory failure caused by diabetic ketoacidosis complicated with pulmonary mucormycosis: a case report and literature review

Objective To investigate the rapid progression and key treatment strategies for invasive pulmonary mucormycosis caused by Rhizopus in patients with diabetic ketoacidosis (DKA). Methods We report a fatal case of severe Rhizopus pneumonia in a patient with DKA and conducted a systematic review of relevant cases from PubMed and Web of Science for descriptive analysis. Results A 39-year-old male with DKA developed severe lung lesions within days post-admission. Despite confirmation via pathological diagnosis and the initiation of liposomal amphotericin B therapy, the patient succumbed rapidly. Incorporating 15 cases identified from the literature, the total cohort comprised 16 patients, yielding an overall mortality rate of 25% (4/16). Cases involving DKA frequently exhibited narrow diagnostic windows and rapid progression to respiratory failure. Most cases (11/15) received amphotericin B-based therapy, and some with localized lesions (7/15) underwent surgical resection. Conclusion Pulmonary mucormycosis with DKA can progress rapidly and carries high risk. Treatment typically involves amphotericin B preparations, supplemented by surgery for focal disease. Key strategies include maintaining a high index of clinical suspicion in high-risk hosts, early pathological/molecular diagnosis, prompt antifungal therapy alongside metabolic correction, and timely surgical evaluation for localized lesions.