Rhino-cerebral mucormycosis misdiagnosed as neuropsychiatric lupus in a 17-year-old diabetic ketoacidosis patient: a case report.

Abstract

Introduction: Two life-threatening fungal infections, zygomycosis and Aspergillosis, frequently occur in immunocompromised individuals. Because of the arterial vessel invasion, early and rapid diagnosis is crucial. Case presentation: A 17-year-old female with a history of photosensitivity presented to the emergency department with loss of consciousness due to diabetic ketoacidosis (DKA). Initial management included intravenous fluids, insulin, and electrolyte correction; further workup revealed juvenile systemic lupus erythematosus (JSLE) based on physical examination and laboratory tests. The patient initially improved with treatment for DKA and restored consciousness, but later developed right eye ptosis, vision problems, and facial numbness; with suspicion of cavernous sinus thrombosis. Due to limited diagnostic resources, a CT scan of the brain was performed which showed only mucosal thickening of the maxillary and ethmoid sinuses. Biopsy from a newly developed lesion on the palate confirmed a rare fungal infection (Aspergillus and Mucormycosis). Despite reduced-dose antifungal therapy due to kidney complications, the patient’s condition deteriorated and she passed away before surgical intervention. Conclusion: Early clinical recognition, prompt diagnosis of mucormycosis, and appropriate intervention are essential to avert the tragic outcome of this fatal disease