# Rhinocerebral Mucormycosis in a Patient With Diabetes: A Rare but Critical Infection in the United Arab Emirates

## TL;DR

A diabetic patient in the UAE developed a rare fungal infection requiring aggressive treatment, leading to recovery.

## Contribution

This case highlights the successful use of unconventional treatment strategies for rhinocerebral mucormycosis.

## Key findings

- The patient showed clinical and biochemical improvement with non-standard antifungal therapies.
- Multidisciplinary treatment including surgery and novel drug administration was effective.
- The case underscores the importance of early suspicion and aggressive management of mucormycosis.

## Abstract

A middle-aged man with no chronic medical conditions presented to the emergency department with flu-like symptoms, breathlessness, and vomiting. Arterial blood gas analysis revealed high blood glucose and an elevated anion-gap metabolic acidosis, suggestive of diabetic ketoacidosis, prompting the initiation of treatment. Neurological examination revealed multiple cranial nerve palsies with cranial mononeuritis multiplex, raising suspicion of rhino-orbito-cerebral mucormycosis. Liposomal amphotericin B was started empirically. Nasal endoscopy and biopsy, along with microbiological evidence, confirmed mucormycosis. Treatment required a multidisciplinary approach involving both medical and surgical specialties. In this case, we utilized treatments beyond current guidelines, including retrobulbar and intrathecal amphotericin in addition to intravenous dual antifungal therapy. Multiple surgical interventions were also performed. Over time, this approach led to clinical and biochemical improvement, allowing the patient to be discharged safely.