Fulminant angioinvasive pulmonary mucormycosis in diabetic ketoacidosis: a case report

Infections caused by Rhizopus species are aggressive invasive fungal diseases primarily affecting metabolically compromised hosts. Pulmonary involvement is diagnostically challenging due to nonspecific clinical and radiological features, often leading to fatal delays. A 30-year-old woman with previously undiagnosed diabetic ketoacidosis (DKA) presented with rapidly progressive pulmonary mucormycosis. Initially mismanaged as community-acquired pneumonia due to misleading serological markers, the patient quickly developed type I respiratory failure. Non-contrast chest CT showed pulmonary infection, while CTA demonstrated typical vascular invasion. The pathogen Rhizopus oryzae was definitively identified by sputum and bronchoalveolar lavage cultures. Early clinical manifestations of pulmonary mucormycosis are non-specific and easily confused with conventional bacterial pneumonia. Clinicians should maintain a high index of suspicion for this disease in patients with diabetes presenting with acute severe pulmonary infection.