SHM Converge Scientific Abstract ePoster Gallery-Breaking the Mold: An Atypical Presentation of Systemic Mucormycosis

Pdf Summary

This case describes an atypical, severe presentation of mucormycosis in an 18-year-old woman with type 1 diabetes. She had recently been hospitalized for a culture-negative peritonsillar abscess and was discharged on amoxicillin-clavulanate and hydrocortisone. Two weeks later, she returned with recurrent neck pain, swelling, and diabetic ketoacidosis.<br /><br />Imaging revealed a right retropharyngeal abscess with occlusion of the right internal carotid artery, and she was intubated and started on empiric antibiotics. Surgical drainage initially grew Candida albicans, prompting narrowing of therapy to ampicillin-sulbactam and fluconazole. Because her neck pain persisted, repeat drainage was performed and grew Saccharomyces cerevisiae. Histopathology raised concern for aspergillosis versus mucormycosis, but definitive identification was difficult because Mucorales can be mistaken for Aspergillus on tissue morphology. Later CT imaging showed angioinvasive disease and skull base osteomyelitis.<br /><br />Diagnosis was ultimately confirmed by microbial cell-free DNA testing, which identified mucormycosis. She was started on amphotericin B and chose life-prolonging treatment with IV amphotericin plus home hospice. Despite treatment, she died from complications of the illness four months after diagnosis.<br /><br />The case highlights the importance of early suspicion and diagnostic testing for mucormycosis in diabetic patients with persistent or unusual signs of infection. It also illustrates how routine cultures and histopathology may delay diagnosis, especially in deep head and neck infections. Early recognition and prompt antifungal therapy are critical to reducing mortality.

Asset Subtitle

Elena K. Roberts

Meta Tag

Author List Elena K. Roberts, Jasmine R. Marcelin, Jill Zabih

Category Clinical Vignettes

Concept Mucormycosis

Concept Amphotericin B

Concept Diabetes Mellitus

Concept Angioinvasion

Concept Microbial Cell-Free DNA Testing

Distinguished Non-Finalist

Presenter Organization University of Nebraska Medical Center

Presenting Author Elena K. Roberts

Track Adult

Keywords

mucormycosis

type 1 diabetes

diabetic ketoacidosis

retropharyngeal abscess

internal carotid artery occlusion

skull base osteomyelitis

amphotericin B

microbial cell-free DNA testing

head and neck infection

angioinvasive fungal disease

Mucormycosis

Amphotericin B

Diabetes Mellitus

Angioinvasion

Microbial Cell-Free DNA Testing