A Rare but Serious Fungal Infection in Type 1 Diabetes: What Parents and Patients Should Know

Rhino-orbital-cerebral mucormycosis (ROCM) is a serious infection caused by Mucorales fungi. It grows rapidly, affects the sinuses, eye area, and brain, and carries a high risk of disability and death if not treated quickly. The infection often begins subtly, with symptoms that can be mistaken for other conditions, leading to delayed diagnosis.

A 14-year-old girl came to the hospital with chest pain and was diagnosed with Type 1 diabetes complicated by diabetic ketoacidosis (DKA)—a serious condition requiring intensive treatment. Within days of DKA treatment, she developed a high fever, nasal congestion, progressive swelling of her eyelids and around her eyes, headache, and dysfunction in her cranial nerves. These new symptoms led doctors to test for infection.

Two diagnostic tests—plasma mNGS (a molecular test) and a biopsy of nasal tissue—both identified the fungus Rhizopus delemar as the cause. This confirmed the diagnosis of ROCM.

The medical team began treatment with liposomal amphotericin B, an antifungal medication given at a dose of 5 mg per kilogram of body weight daily, combined with nasal endoscopic surgery to remove infected tissue. Initially, the infection was controlled. However, serious complications emerged: anemia (low red blood cell count) worsened, and the patient developed severe low potassium levels. These side effects required close monitoring and management.

After a four-week course of antifungal treatment and multidisciplinary care led by clinical pharmacists, the patient's condition stabilized. The case underscores how important it is for different medical specialists to work together to optimize medication regimens and monitor for harmful side effects.

While ROCM is rare, people with Type 1 diabetes—particularly during DKA—are at higher risk. Currently, there are no established clinical guidelines for diagnosing and treating mucormycosis in children, making each case a clinical challenge. This case report documents a complete diagnostic and treatment process, which may help medical teams recognize and respond to similar presentations more quickly.

If you or your child experience fever, nasal congestion, facial or eye swelling, headache, or vision changes during or after DKA treatment, seek urgent medical attention. Early detection and rapid treatment are critical.

Source: Frontiers in medicine. Evidence type: PubMed indexed literature. Type1Cure is an information and intelligence hub, not a medical advice service. This article summarizes published research and does not provide diagnosis, treatment, or personal medical guidance. Always talk to your own care team before changing anything about your Type 1 diabetes management.