P-293: Type 1 diabetes complicated by mucormycosis: experience from a tertiary care center
S Tahseen, D S Aftab, D FayyazAbstract
Introduction
Mucormycosis remains a devastating opportunistic fungal infection with reported global mortality rates ranging from 40–80%, particularly high in cases of rhino-orbito-cerebral involvement and diabetic ketoacidosis (DKA). Paediatric data is limited and outcomes are poor due to delayed diagnosis and suboptimal metabolic control
Objectives
To determine the clinical spectrum and long term outcome of children and adolescents with type 1 diabetes presented with mucormycosis at a single tertiary care center over last 2 years.
Methods
A retrospective review was conducted of all children with type 1 diabetes and mucormycosis presenting to the Department of Pediatric Endocrinology, The Children Hospital Lahore, over a two-year period (2024–2026), to evaluate their clinical spectrum and long-term outcomes
Results
Amphotericin B was initiated on clinical suspicion within 48 hours in all cases along with DKA management.Surgical debridement of necrosed tissue was performed, with histopathology demonstrating non-septated hyphae and angioinvasion. 1 child died within 48 hours due to severe DKA, sepsis, and multi-organ failure before surgical intervention.After multidisciplinary team discussion, surgical management including orbital exenteration, sinus washout, and repeated debridement was performed. 5 children were discharged after 3 months of intravenous amphotericin B when two imaging studies, one month apart, confirmed no disease progression.In our cohort, Amphotericin B–induced nephrotoxicity was noted in 2 patients, was transient, resolved with hydration and dose adjustment. Two patients developed peripheral neuropathy.Patients with intracranial involvement remained stable at 1 year follow-up without disease progression. Overall survival was 83%, better than reported series.
Conclusions
This case series suggests that timely diagnosis, good glycemic control, early intervention and multidisciplinary care enhances outcomes.