Successful Outcome of Rhino-Orbital-Cerebral Mucormycosis With Extensive Intracranial Disease in a Patient With Poorly Controlled Diabetes

Rhino-orbital-cerebral mucormycosis is a life-threatening infection typically requiring complete surgical debridement of necrotic tissue for survival. The authors have reported a case of invasive mucormycosis in a 22-year-old female with severe diabetic ketoacidosis and recent COVID-19 infection. The patient developed extensive intracranial disease, including cavernous sinus thrombosis and internal carotid artery occlusion, which precluded complete surgical source control without extensive morbidity. Facing such circumstance, a multidisciplinary team pursued an aggressive, individualized multimodal strategy. This included high-dose liposomal amphotericin B, targeted serial endoscopic debridements of extracranial disease, and adjunctive therapies comprising iron chelation (deferasirox), hyperbaric oxygen, and combination antifungal therapy with caspofungin and posaconazole. Despite the inability to achieve complete surgical clearance, this regimen halted disease progression and resulted in clinical and radiological regression. This case illustrated that a coordinated, multimodal approach utilizing aggressive medical management can achieve favorable outcomes in select patients with otherwise inoperable, extensive intracranial mucormycosis.