A Rare Battle: Multidisciplinary Care for a Child with Rhino-Orbital Cerebral Mucormycosis in Somali Region of Ethiopia
Abdirashid Abdirahman Hussein,1 Mahamed Mahamoud Mahamed,1 Habtamu Dildil,1 Ismail Abdulahi,2 Abdulaziz Ibrahim Osmael,3 Sebsbie Admas,4 Mohamoud Hashi Abdi,5 Abdirahman Omer Ali6 1Department of Pediatrics and Child Health, Jigjiga University Sh. Hassan Yabare Comprehensive Specialized Hospital, Jig...
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Dove Medical Press
2025-06-01
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| author | Hussein AA Mahamed MM Dildil H Abdulahi I Osmael AI Admas S Abdi MH Ali AO |
| author_facet | Hussein AA Mahamed MM Dildil H Abdulahi I Osmael AI Admas S Abdi MH Ali AO |
| author_sort | Hussein AA |
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| description | Abdirashid Abdirahman Hussein,1 Mahamed Mahamoud Mahamed,1 Habtamu Dildil,1 Ismail Abdulahi,2 Abdulaziz Ibrahim Osmael,3 Sebsbie Admas,4 Mohamoud Hashi Abdi,5 Abdirahman Omer Ali6 1Department of Pediatrics and Child Health, Jigjiga University Sh. Hassan Yabare Comprehensive Specialized Hospital, Jigjiga, Ethiopia; 2ENT Department, Jigjiga University Sh. Hassan Yabare Comprehensive Specialized Hospital, Jigjiga, Ethiopia; 3Ophthalmology Department, Jigjiga University Sh. Hassan Yabare Comprehensive Specialized Hospital, Jigjiga, Ethiopia; 4Department of Clinical Radiology, Jigjiga University Sh. Hassan Yabare Comprehensive Specialized Hospital, Jigjiga, Ethiopia; 5Radiology Department, Borama Regional Hospital, Borama, Somalia; 6Family Medicine, Borama Regional Hospital, Borama, SomaliaCorrespondence: Abdirahman Omer Ali, Email abdirahman.omer@amoud.edu.soBackground: 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.Keywords: mucormycosis, rhino-orbital-cerebral mucormycosis, pediatric, diabetic ketoacidosis, Ethiopia, resource-limited setting, fungal infection |
| format | Article |
| id | doaj-art-e5fe32d714fa4c09b77e4370737dc876 |
| institution | Kabale University |
| issn | 1179-142X |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | International Medical Case Reports Journal |
| spelling | doaj-art-e5fe32d714fa4c09b77e4370737dc8762025-08-20T03:29:52ZengDove Medical PressInternational Medical Case Reports Journal1179-142X2025-06-01Volume 18Issue 1769776104203A Rare Battle: Multidisciplinary Care for a Child with Rhino-Orbital Cerebral Mucormycosis in Somali Region of EthiopiaHussein AA0Mahamed MM1Dildil H2Abdulahi I3Osmael AI4Admas S5Abdi MH6Ali AO7Pediatric residentPediatric residentPediatrics and child healthENT departmentOphthalmology departmentClinical RadiologyClinical RadiologyPediatric departmentAbdirashid Abdirahman Hussein,1 Mahamed Mahamoud Mahamed,1 Habtamu Dildil,1 Ismail Abdulahi,2 Abdulaziz Ibrahim Osmael,3 Sebsbie Admas,4 Mohamoud Hashi Abdi,5 Abdirahman Omer Ali6 1Department of Pediatrics and Child Health, Jigjiga University Sh. Hassan Yabare Comprehensive Specialized Hospital, Jigjiga, Ethiopia; 2ENT Department, Jigjiga University Sh. Hassan Yabare Comprehensive Specialized Hospital, Jigjiga, Ethiopia; 3Ophthalmology Department, Jigjiga University Sh. Hassan Yabare Comprehensive Specialized Hospital, Jigjiga, Ethiopia; 4Department of Clinical Radiology, Jigjiga University Sh. Hassan Yabare Comprehensive Specialized Hospital, Jigjiga, Ethiopia; 5Radiology Department, Borama Regional Hospital, Borama, Somalia; 6Family Medicine, Borama Regional Hospital, Borama, SomaliaCorrespondence: Abdirahman Omer Ali, Email abdirahman.omer@amoud.edu.soBackground: 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.Keywords: mucormycosis, rhino-orbital-cerebral mucormycosis, pediatric, diabetic ketoacidosis, Ethiopia, resource-limited setting, fungal infectionhttps://www.dovepress.com/a-rare-battle-multidisciplinary-care-for-a-child-with-rhino-orbital-ce-peer-reviewed-fulltext-article-IMCRJMucormycosisRhino-orbital-cerebral mucormycosisPediatricDiabetic KetoacidosisEthiopiaResource-Limited Setting |
| spellingShingle | Hussein AA Mahamed MM Dildil H Abdulahi I Osmael AI Admas S Abdi MH Ali AO A Rare Battle: Multidisciplinary Care for a Child with Rhino-Orbital Cerebral Mucormycosis in Somali Region of Ethiopia International Medical Case Reports Journal Mucormycosis Rhino-orbital-cerebral mucormycosis Pediatric Diabetic Ketoacidosis Ethiopia Resource-Limited Setting |
| title | A Rare Battle: Multidisciplinary Care for a Child with Rhino-Orbital Cerebral Mucormycosis in Somali Region of Ethiopia |
| title_full | A Rare Battle: Multidisciplinary Care for a Child with Rhino-Orbital Cerebral Mucormycosis in Somali Region of Ethiopia |
| title_fullStr | A Rare Battle: Multidisciplinary Care for a Child with Rhino-Orbital Cerebral Mucormycosis in Somali Region of Ethiopia |
| title_full_unstemmed | A Rare Battle: Multidisciplinary Care for a Child with Rhino-Orbital Cerebral Mucormycosis in Somali Region of Ethiopia |
| title_short | A Rare Battle: Multidisciplinary Care for a Child with Rhino-Orbital Cerebral Mucormycosis in Somali Region of Ethiopia |
| title_sort | rare battle multidisciplinary care for a child with rhino orbital cerebral mucormycosis in somali region of ethiopia |
| topic | Mucormycosis Rhino-orbital-cerebral mucormycosis Pediatric Diabetic Ketoacidosis Ethiopia Resource-Limited Setting |
| url | https://www.dovepress.com/a-rare-battle-multidisciplinary-care-for-a-child-with-rhino-orbital-ce-peer-reviewed-fulltext-article-IMCRJ |
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