Rhino-orbito-cerebral mucormycosis in a 42-year-old type II diabetes patient: a case report from Ethiopia

Background: Mucormycosis is a severe fungal infection that can progress quickly with high mortality, primarily affecting individuals with weakened immune systems, such as those with retroviral infections or cancer. Symptoms vary by infection site, with rhino-orbito-cerebral mucormycosis presenting nasal congestion and facial swelling, pulmonary mucormycosis causing cough and chest pain, cutaneous mucormycosis resulting in skin lesions, and gastrointestinal mucormycosis leading to abdominal issues. This case report highlights a case of a 42-year-old patient with type II diabetes mellitus presenting with facial swelling and visual loss of 12 days duration, which developed after tooth extraction. Case presentation: A 42-year-old Ethiopian woman who is a known patient with type II diabetes mellitus that claims to be adherent to her oral anti-diabetic medications presented with facial swelling, visual loss, and a right-sided spastic type of hemiplegia, all after decayed tooth extraction. She denied having a history of chronic headache, thyroid disease, trauma, or any other chronic medical disorders. On physical examination, she was acutely sick-looking with blood pressure of 130/80 mmHg, a pulse rate of 112 beats per minute, a respiratory rate of 26 breaths per minute, a temperature of 38°C, oxygen saturation of 93% at room air, and a body mass index of 21 kg/m². Further evaluation revealed a black eschar in the hard palate, while evaluations of the respiratory system, cardiovascular system, abdomen, musculoskeletal system, and other neurologic evaluations were unremarkable. Investigations with neck and head CT scans showed a hyperdense lesion involving bilateral maxillary sinuses and the right fronto-ethmoidal sinus that was later confirmed to be rhino-cerebral mucormycosis, with hypodensity in the right basal ganglia, temporal, and frontal cortex. Conclusion: Mucormycosis is a serious fungal illness that can quickly cause disability and death. A high level of attention is required, particularly in patients at risk of immunological compromise, including those with diabetes mellitus, to initiate appropriate therapy and prevent morbidity and death. An early multidisciplinary approach is critical for effective care. Furthermore, good diabetes control combined with improved periprocedural care, including possible antibiotics, may decrease invasive fungal infections.