To describe the diagnostic and treatment process for a 14-year-old female patient with type 1 diabetes mellitus who developed rhino-orbital-cerebral mucormycosis following diabetic ketoacidosis.
Approach:
Patient Admission and Initial Diagnosis: A 14-year-old female was admitted with chest pain and diagnosed with type 1 diabetes mellitus complicated by diabetic ketoacidosis.
Development of Symptoms: During DKA treatment, the patient developed high fever, nasal congestion, eyelid swelling, headache, and cranial nerve dysfunction.
Diagnosis Confirmation: Plasma mNGS and nasal mucosa biopsy confirmed the presence of Rhizopus delemar, indicating ROCM.
Initial Treatment: Initial treatment included liposomal amphotericin B and nasal endoscopic debridement, which initially controlled the infection.
Treatment Adjustment: After 16 days, treatment was adjusted due to anemia and hypokalemia, incorporating oral isavuconazole and intranasal amphotericin B deoxycholate.
Follow-Up: After 4 months, facial swelling resolved, olfaction recovered, and no significant adverse drug reactions occurred.
Key Findings:
Non-specific prodromal symptoms such as headache and facial swelling should be closely monitored in adolescents with T1DM.
A multi-modal diagnostic approach combining mNGS and tissue biopsy was essential for early diagnosis in this case.
The antifungal regimen was individualized based on the patient's response and organ function.
Interpretation:
In this case, clinical pharmacists were integral in adjusting the treatment plan based on the patient's evolving condition and monitoring for adverse effects.
Limitations:
The absence of established treatment guidelines for mucormycosis in pediatric patients limits the applicability of findings.
As a case report, the findings may not be generalizable to all patients with similar conditions.
Conclusion:
This case emphasizes the necessity of early diagnosis and tailored treatment strategies for managing ROCM in adolescents with T1DM, highlighting the importance of a multidisciplinary approach.
