Review of 16 cases shows 25% mortality for pulmonary mucormycosis in DKA patients treated with amphotericin B

ObjectiveTo investigate the rapid progression and key treatment strategies for invasive pulmonary mucormycosis caused by Rhizopus in patients with diabetic ketoacidosis (DKA).MethodsWe report a fatal case of severe Rhizopus pneumonia in a patient with DKA and conducted a systematic review of relevant cases from PubMed and Web of Science for descriptive analysis.ResultsA 39-year-old male with DKA developed severe lung lesions within days post-admission. Despite confirmation via pathological diagnosis and the initiation of liposomal amphotericin B therapy, the patient succumbed rapidly. Incorporating 15 cases identified from the literature, the total cohort comprised 16 patients, yielding an overall mortality rate of 25% (4/16). Cases involving DKA frequently exhibited narrow diagnostic windows and rapid progression to respiratory failure. Most cases (11/15) received amphotericin B-based therapy, and some with localized lesions (7/15) underwent surgical resection.ConclusionPulmonary mucormycosis with DKA can progress rapidly and carries high risk. Treatment typically involves amphotericin B preparations, supplemented by surgery for focal disease. Key strategies include maintaining a high index of clinical suspicion in high-risk hosts, early pathological/molecular diagnosis, prompt antifungal therapy alongside metabolic correction, and timely surgical evaluation for localized lesions.