All That Swells Is Not Allergy: Unmasking Rhino-Orbital-Cerebral Mucormycosis in Diabetic Ketoacidosis.

Rhino-orbital-cerebral mucormycosis (ROCM) is the most common manifestation of mucormycosis in uncontrolled diabetes and diabetic ketoacidosis (DKA). This infection is extremely aggressive, invading blood vessels and spreading quickly from the sinuses to the orbit and brain. We present a case of a 57-year-old male with poorly controlled type 2 diabetes who came to the hospital with facial swelling, blurry vision, and severe DKA. Imaging revealed orbital cellulitis, sinusitis with gas formation, and cavernous sinus thrombosis. He underwent an urgent lateral canthotomy and surgical debridement. Pathology confirmed invasive mucormycosis, and he was started on liposomal amphotericin B. Despite aggressive treatment, the infection progressed to the brain, causing multiple strokes. The patient's condition continued to decline, and he was eventually transitioned to hospice care. This case emphasizes the importance of early recognition of mucormycosis in high-risk patients to prompt urgent evaluation. Because the infection spreads so rapidly and antifungal medications penetrate the brain poorly, early surgical intervention and systemic therapy are vital.