Abstract Mucormycosis is a rare but life-threatening fungal infection caused by fungi of the order Mucorales, most commonly Rhizopus species. Pulmonary mucormycosis is the second most frequent manifestation after rhino-orbital-cerebral involvement. Diabetic patients, particularly those in diabetic ketoacidosis (DKA), are at heightened risk due to impaired neutrophil function and elevated free iron levels that facilitate fungal proliferation. We present a series of three cases of isolated pulmonary mucormycosis in patients with uncontrolled diabetes. Case 1: A 64-year-old male with poorly controlled type 2 diabetes (HbA1c 14%) presented with a progressive cavitary right upper lobe lesion. Initially misdiagnosed as aspergillosis, fungal cultures later confirmed Rhizopus species. He was successfully treated with IV amphotericin B followed by surgical lobectomy and long-term antifungal therapy. Case 2: A 39-year-old male with newly diagnosed diabetes presented in severe DKA and influenza A infection. Rapid respiratory deterioration led to mechanical ventilation. Bronchoalveolar lavage confirmed Rhizopus species. Despite antifungal therapy, he developed multiorgan failure and expired. Case 3: A 25-year-old female with type 1 diabetes (HbA1c 14.6%) and concurrent influenza A presented with DKA and respiratory distress. Bronchoscopy confirmed pulmonary mucormycosis. Her course was complicated by ARDS, mediastinitis, and tracheoesophageal fistula. Despite aggressive antifungal therapy and supportive care, she succumbed to disseminated fungal sepsis and multiorgan failure. These cases highlight pulmonary mucormycosis as an aggressive opportunistic infection with high mortality in the setting of uncontrolled diabetes and metabolic derangement. Hyperglycemia impairs innate immunity and fosters fungal invasion by enhancing iron availability and endothelial receptor expression. Pulmonary involvement often mimics other infections radiographically, necessitating early tissue diagnosis. Mortality remains high—up to 60%—with delayed diagnosis or absent surgical intervention. Lipid-formulated amphotericin B remains first-line therapy, with isavuconazole or posaconazole as adjuncts. Combined surgical resection and antifungal therapy significantly improve survival compared to medical management alone. Uncontrolled diabetes, especially in the setting of DKA, predisposes patients to pulmonary mucormycosis with devastating outcomes. Early recognition, prompt initiation of antifungal therapy, aggressive metabolic correction, and multidisciplinary management—including surgical evaluation—are critical to improving survival in this high-risk population. This abstract is funded by: none
Sum et al. (Fri,) studied this question.