Delayed Diagnosis of Rhino-Orbito-Facial Mucormycosis in a Patient With Newly Diagnosed Diabetes and Diabetic Ketoacidosis: A Successful Case From a Resource-Limited Setting.

BACKGROUND

Rhino-orbito-facial mucormycosis is a rapidly progressive, life-threatening fungal infection that predominantly affects patients with uncontrolled diabetes mellitus, particularly those with diabetic ketoacidosis (DKA). Early diagnosis remains challenging in resource-limited settings because initial manifestations often mimic bacterial sinusitis.

CASE PRESENTATION: We report a 38-year-old woman with newly diagnosed diabetes mellitus presenting with left facial pain, swelling, and nasal discharge accompanied by mild DKA. She was initially treated for bacterial maxillary sinusitis with antibiotics and insulin therapy; however, progressive facial necrosis and subsequent orbital involvement prompted surgical debridement and histopathological examination, which confirmed mucormycosis. The patient underwent repeated surgical debridement, conventional amphotericin B therapy, and intensive glycemic control, resulting in complete clinical recovery without recurrence during 3 years of follow-up.

CONCLUSION

This case highlights the diagnostic challenges of mucormycosis in resource-limited settings and emphasizes the importance of maintaining a high index of suspicion in diabetic patients whose facial or orbital symptoms worsen despite appropriate antibacterial therapy. Early histopathological confirmation, prompt antifungal treatment, and multidisciplinary management remain essential for improving outcomes, even when advanced diagnostic resources are limited.