# Delay in the Diagnosis of Osteoarticular Mucormycosis in Diabetic Ketoacidosis: A Learning Opportunity

## TL;DR

A diabetic patient was misdiagnosed with a bacterial infection instead of a rare fungal infection, leading to delayed treatment and poor outcomes.

## Contribution

This case highlights the importance of early diagnosis of osteoarticular mucormycosis in diabetic patients.

## Key findings

- Osteoarticular mucormycosis is a rare and often misdiagnosed condition in diabetic patients.
- Delayed diagnosis can result in discharge without appropriate antifungal treatment.
- Early recognition and biopsy are critical for effective management.

## Abstract

Mucormycosis is a rare, opportunistic, and life-threatening fungal infection caused by fungi of the order Mucorales, which includes Rhizopus, Mucor,and Rhizomucor. This disease occurs in immunocompromised patients such as those with uncontrolled diabetes mellitus, hematologic malignancies, transplants, trauma, burns, or receiving glucocorticoid therapy. Mucormycosis can present in various ways, including rhino-orbital-cerebral, pulmonary, cutaneous, gastrointestinal, and disseminated disease. Osteoarticular mucormycosis, with the exclusion of bone extension from rhinosinusitis, is an exceedingly rare manifestation. Here, we present a 48-year-old female with uncontrolled type 1 diabetes mellitus who presented with diabetic ketoacidosis. During her hospital course, it was discovered that she had fallen in the woods before presentation, which caused her to develop a left knee wound concerning for osteomyelitis. After symptomatic improvement with antibiotics, she was discharged home, only for us to find out afterwards that her wound biopsy culture grew Rhizopus; thus, diagnosing her osteoarticular mucormycosis. She unfortunately was lost to follow-up and was never able to get started on the appropriate treatment. We discuss the clinical manifestations, useful diagnostic tools, and treatment of osteoarticular mucormycosis. We also reflect on how our delay in diagnosis led to our patient being discharged without appropriate treatment in hopes of avoiding similar situations in the future.