Rhino-orbito-cerebral mucormycosis in new-onset type 1 diabetes mellitus: a case-based short review

Isabella Sharifi; Alejandra Razzeto; Susana Barreiro Sacco; Mariana Zamin; Viviana Valencia; Marie Louise Aoun; Ron T Varghese

doi:10.1016/j.amjms.2026.03.003

Rhino-orbito-cerebral mucormycosis in new-onset type 1 diabetes mellitus: a case-based short review

Am J Med Sci. 2026 Mar 5:S0002-9629(26)00105-9. doi: 10.1016/j.amjms.2026.03.003. Online ahead of print.

Authors

Isabella Sharifi¹, Alejandra Razzeto¹, Susana Barreiro Sacco¹, Mariana Zamin¹, Viviana Valencia¹, Marie Louise Aoun¹, Ron T Varghese²

Affiliations

¹ Division of Endocrinology, Department of Internal Medicine, University of Miami Miller School of Medicine, 1450 Northwest 10th Avenue, Miami, FL 33136, USA.
² Division of Endocrinology, Department of Internal Medicine, University of Miami Miller School of Medicine, 1450 Northwest 10th Avenue, Miami, FL 33136, USA. Electronic address: rxv492@med.miami.edu.

PMID: 41794396
DOI: 10.1016/j.amjms.2026.03.003

Abstract

Mucormycosis is an aggressive angioinvasive fungal infection that commonly involves the paranasal sinuses, orbit, lungs, and central nervous system (CNS). Patients with diabetic ketoacidosis (DKA) are uniquely susceptible because hyperglycemia and acidosis enhance fungal invasion and blunt innate immune defenses. We present a brief vignette of rhino-orbito-cerebral mucormycosis in a patient with recent diagnosis of type 1 diabetes mellitus (DM), and use it to frame a short review of epidemiology, pathogenesis, diagnosis, and management. Rapid recognition, urgent surgical debridement, prompt initiation of high-dose liposomal amphotericin B, and reversal of metabolic derangements remain cornerstones of care. Emerging developments include broader use of isavuconazole and posaconazole as step-down therapy and expanding molecular diagnostics, including serum Mucorales polymerase chain reaction, that may enable earlier detection and treatment monitoring. Because outcomes are strongly time-dependent, clinicians should maintain a low threshold for multidisciplinary evaluation when invasive fungal sinusitis is suspected in patients with DM.

Keywords: Amphotericin B; Diabetic ketoacidosis; Invasive fungal sinusitis; Mucormycosis; Rhino-orbito-cerebral.

Publication types

Review