# Diabetes-associated central nervous system mucormycosis with delayed diagnosis: a case report

## TL;DR

A case report describes a fatal CNS fungal infection in a diabetic patient with delayed diagnosis, emphasizing the need for early detection and treatment.

## Contribution

This case highlights the diagnostic challenges and rapid progression of CNS mucormycosis in diabetic patients with COVID-19.

## Key findings

- CNS mucormycosis was diagnosed using metagenomic next-generation sequencing of cerebrospinal fluid.
- The patient's death was attributed to multi-organ failure from disseminated mucormycosis despite treatment.
- Uncontrolled diabetes and COVID-19 were identified as critical risk factors for severe mucormycosis.

## Abstract

Central nervous system (CNS) mucormycosis is a rare, life-threatening fungal infection predominantly affecting diabetic and immunocompromised patients. Early diagnosis remains challenging, resulting in poor outcomes. We report a case highlighting the diagnostic challenges and rapid progression in a patient with uncontrolled diabetes and COVID-19 infection.

A 31-year-old male with untreated type 2 diabetes mellitus presented with severe pneumonia due to COVID-19 infection. His condition rapidly deteriorated, developing CNS symptoms and characteristic nasal lesions. Cerebrospinal fluid (CSF) analysis revealed lymphocytic pleocytosis, high protein, and low glucose. Metagenomic next-generation sequencing (mNGS) of CSF confirmed Rhizopus oryzae infection. Despite initiating amphotericin B therapy, his condition worsened.

The patient succumbed to progressive multi-organ failure secondary to disseminated mucormycosis. This case emphasizes the significance of uncontrolled diabetes and COVID-19 as critical risk factors and highlights the diagnostic utility of CSF mNGS.

Prompt recognition of risk factors, early utilization of advanced diagnostic methods, and aggressive treatment are essential to improve outcomes in CNS mucormycosis.