Invasive tracheal mucormycosis causing irreversible glottic closure and long-term tracheostomy dependence: a case report and airway-centered management implications.

Invasive tracheal mucormycosis is a rare but rapidly progressive central airway fungal infection associated with high mortality. Its early clinical manifestations and radiological features are often nonspecific, which may result in delayed diagnosis. We report a case of invasive tracheal mucormycosis in a patient with diabetic ketosis. The patient underwent emergency tracheostomy for necrotizing upper airway obstruction. Bronchoscopic examination revealed extensive white necrotic tissue in the subglottic region and trachea. Broad, ribbon-like, pauci-septate hyphae were identified in both bronchoalveolar lavage fluid and biopsy specimens, establishing the diagnosis. Following systemic antifungal therapy with amphotericin B, adjunctive nebulized local treatment, and repeated bronchoscopic interventions, the infection was controlled, and maintenance therapy was sequentially transitioned to oral isavuconazole. However, the patient ultimately developed irreversible glottic closure and severe subglottic stenosis, resulting in long-term tracheostomy dependence. This case highlights that mucormycosis should be considered early in the differential diagnosis of patients with diabetes, particularly those with diabetic ketosis, who present with necrotizing or pseudomembranous airway lesions on bronchoscopy and non response to broad spectrum antibiotics. Deep respiratory specimens should be obtained promptly to establish etiological and histopathological diagnoses, while adequate antifungal therapy and correction of metabolic disturbances should be initiated simultaneously to improve outcomes. Nevertheless, even after infection control is achieved, patients may still be left with severe structural airway damage. Therefore, airway function preservation and long-term prognostic assessment should also be emphasized in clinical management.