Surviving the odds: Pediatric rhino-orbito-cerebral mucormycosis with internal carotid artery involvement in a child with type 1 diabetes mellitus

Rhino-orbito-cerebral mucormycosis (ROCM) is a rapidly progressive and often fatal opportunistic fungal infection predominantly affecting individuals with underlying metabolic and immunological compromise. Intracranial extension of the disease has invariably been associated with a high rate of mortality. Here, we present a child with type 1 diabetes mellitus diagnosed with ROCM and complete occlusion of the ipsilateral internal carotid artery, who underwent aggressive multimodality treatment with a combination of systemic liposomal amphotericin B, oral posaconazole, and intraconal liposomal amphotericin B, along with surgical debridement. The multimodality approach used in this case, comprising prolonged intravenous antifungal therapy with a defined cumulative dose, oral azole therapy, adjunctive local antifungal administration, and repeated surgical debridement, resulted in a favorable outcome. Despite intracranial extension with vascular involvement, the patient demonstrated a long-term survival with good neurological recovery.