Endocrine Abstracts

JOINT222

Background: A relatively uncommon infection, mucormycosis, in diabetes, stood out as the main underlying medical comorbidity for the infected patients. It was determined to be an independent risk factor for severe infection depending on which organ was affected. Mucormycosis detects several host-dependent clinical manifestations. Factors that impede host immune function can also play a role in the aggressiveness of mucormycosis infection. Mucormycosis have also been well studied with regard to the effects of hyperglycemia, and acidosis on their pathogenesis. The purpose of this paper is to present a case successfully management of type 1 diabetes mellitus (DMT1) with mucormycosis.

Case: S, a 10-year-old girl, was admitted to Soetomo Hospital, East Java, Indonesia, with complaints of fever accompanied by abdominal pain and a subsequent loss of consciousness. The patient was diagnosed with diabetic ketoacidosis (DKA) and type 1 diabetes mellitus (HbA1c 9.9%, blood glucose 478 mg/dL). Further examination revealed the presence of a white plaque on the soft palate (palatum molle) along with a perforation in the area. Additionally, the patient exhibited facial paralysis on one side. Laboratory findings and investigations conducted revealed the following: a pathological anatomy biopsy indicated chronic suppurative inflammation consistent with a nonspecific abscess; the C-peptide level was 0.193 ng/mL; ASTO was 315.27 IU/mL (normal range: < 200 IU/mL); the anti-dsDNA antibody test was negative; blood culture was sterile, and urine culture revealed the presence of Candida glabrata. A palatal swab culture identified Candida dubliniensis and mucormycosis. Additionally, Acinetobacter baumannii was detected in the palatal swab. The patient only received a 3-day treatment due to difficulties in obtaining amphotericin-B. However, she underwent surgical debridement performed by the surgery department to aid in wound healing. Despite the limited treatment duration, the patient successfully recovered, and the wound healed completely. After a few months of recovery and rehabilitation, patients can walk and eat well and go to school again.

Conclusion: Early diagnosis for mucormycosis is a key to rapid and appropriate treatment and better outcomes. Underlying risk factors influence the clinical presentation. The cornerstone for management of invasive mucormycosis involves surgical debridement and antifungal therapies.