Abstract
BACKGROUND: Rhino-orbital-cerebral mucormycosis (ROCM) is a rare, aggressive fungal infection with high mortality, primarily affecting immunocompromised individuals, especially those with uncontrolled diabetes mellitus, though it can occur in immunocompetent hosts. Cerebral involvement carries a near 100% fatality rate if untreated, and overall mortality remains high (>30%) even with therapy. We present a pediatric ROCM case from the resource-limited Somali region of Ethiopia. CASE PRESENTATION: A 12-year-old female with type 1 diabetes mellitus presented with a 10-day history rapidly progressing from headache and fever to right-sided periorbital swelling, proptosis, vision loss, and a necrotic eschar. She had uncontrolled hyperglycemia and diabetic ketoacidosis (DKA) upon arrival. Imaging via CT and MRI revealed findings highly suggestive of ROCM, demonstrating right orbital involvement, cavernous sinus thrombosis, and further intracranial extension including cerebral abscesses/cerebritis and meningeal enhancement. Microbiological confirmation was unavailable due to resource limitations. Treatment included intravenous liposomal amphotericin B (requiring dose adjustment for transient nephrotoxicity), extensive endoscopic nasal debridement, right eye exenteration, and intensive glycemic control. DISCUSSION AND CONCLUSION: This case highlights the diagnostic and management challenges of ROCM in resource-limited settings. Despite the high mortality associated with ROCM, particularly in children, the patient improved significantly and was discharged in good health, albeit with persistent visual impairment. Successful management involved prompt recognition, aggressive multimodal therapy (medical and surgical), and close multidisciplinary collaboration (Pediatrics, Ophthalmology, ENT). This outcome demonstrates the feasibility of successful treatment even in resource-constrained environments and underscores the critical importance of managing underlying conditions like diabetes to prevent opportunistic infections.