Late diagnosis of invasive mucormycosis in a female patient with diabetic ketoacidosis. Clinical case
Ryabkova N.L., Petrova E.G., Morozov I.V.
Background: Invasive fungal infections remain a serious diagnostic challenge, despite advances in medical science. The purpose of this publication is to present a case of late diagnosis of invasive mucormycosis in a female patient with diabetic ketoacidosis.
Description of the clinical case: A 64-year-old female patient was admitted to the intensive care unit of the V.A. Baranov Republican Hospital in critical condition and diagnosed with diabetic ketoacidosis. During treatment, a deterioration in her condition was observed, with multiple organ failure developing. Sepsis with an unspecified source of infection was diagnosed. Syndromic therapy was administered, including antibiotics, vasopressors, mechanical ventilation, and renal replacement therapy. Her condition progressively worsened. Brain computed tomography (CT) scan was performed, which diagnosed sinus thrombosis, extensive ischemic stroke, and polysinusitis. Subsequently, atonic coma and death ensued. Histological examination revealed mycelium of the Mucorales fungus in thrombotic masses within the lumen of the left internal carotid artery, branches of the pulmonary artery, vessels of the pia mater, pia mater with invasion of brain tissue, vessels of the brainstem, and pneumonic foci in the lungs.
Conclusion: In intensive care unit patients with risk factors for invasive mycosis, a suspected infectious origin of fever, and failure of adequate antimicrobial therapy within 72 hours, high-resolution CT scanning of the chest and paranasal sinuses is required, followed by obtaining biopsy specimens for microscopy and histological examination. Serological tests are performed to differentiate from other mycoses, and antifungal therapy should be initiated before obtaining test results if systemic mycosis is clinically suspected. The availability of approved Russian clinical guidelines for mucormycosis appears essential.
For citations: Ryabkova N.L., Petrova E.G., Morozov I.V. Late diagnosis of invasive mucormycosis in a female patient with diabetic ketoacidosis. Clinical case. Pharmateca. 2026;33(2):146-152. (In Russ.). DOI: https://dx.doi.org/10.18565/pharmateca.2026.2.146-152
Authors’ contribution: N.L. Ryabkova – study concept and design, writing. E.G. Petrova and I.V. Morozov – data collection, processing, and editing.
Conflicts of interest: The authors confirm that they have no conflicts of interest to declare.
Funding: The study was conducted without any sponsorship.
Keywords
invasive fungal infections
disseminated mucormycosis
risk factors for mucormycosis
diabetic ketoacidosis
About the Authors
N.L. Ryabkova, Cand. Sci. (Med.), Associate Professor, Department of Hospital Therapy, Prof. A.P. Zilber Medical Institute, PetrozavodskState University; Clinical Pharmacologist, V.A. Baranov Republican Hospital, Petrozavodsk, Russia; nadl-ryabkova@yandex.ru, ORCID:
https://orcid.org/0000-0002-9434-7931, eLibrary SPIN: 3652-4255 (corresponding author)
E.G. Petrova, Endocrinologist, Head of the Endocrinology Department, V.A. Baranov Republican Hospital, Petrozavodsk, Russia; ORCID:
https://orcid.org/0009-0006-2917-8090
I.V. Morozov, Pathologist, Head of the Anatomic Pathology Department, V.A. Baranov Republican Hospital, Petrozavodsk, Russia; ORCID:
https://orcid.org/0009-0000-8443-8138
Similar Articles
