Abstract:

Objective To investigate the key factors influencing the prognosis of pulmonary mucormycosis in children with diabetes mellitus, and to provide evidence for early identification of high-risk patients and optimization of diagnostic and therapeutic strategies. Methods A retrospective analysis was conducted on the clinical data of 8 children with diabetes mellitus complicated with pulmonary mucormycosis admitted to the Department of Respiratory from April 2021 to January 2026, including clinical manifestations, imaging features, etiological detection, treatment plans and prognosis. Results Eight patients, with a median age of 13.5 (12-16) years, were included in this study, of whom six (75%) were female. Five patients (62.5%) had type 1 diabetes mellitus, all complicated by severe diabetic ketoacidosis (DKA). All patients presented with fever and cough, and three (37.5%) experienced hemoptysis. Insulin therapy was initiated promptly following the diagnosis of diabetes, and glycemic control was subsequently achieved. The interval from diabetes diagnosis to initiation of antifungal therapy, with a median of 21 (3-60) days. All eight patients received combination antifungal therapy with liposomal amphotericin B plus either posaconazole or isavuconazole. One patient, in whom antifungal therapy was started within 14 days of diagnosis, achieved clinical cure. In the remaining seven patients, in whom antifungal therapy was initiated 14 days or more after diagnosis, two required lobectomy or pneumonectomy for hemoptysis, four improved with medical management alone, and one died. The seven surviving patients were followed up at regular intervals of 3 to 6 months after discharge, with the last follow-up visit conducted in June 2026. The median duration of follow-up was 9 (5-24) months. At the time of the last follow-up, chest computed tomography in all surviving patients demonstrated further resolution or stability of pulmonary lesions compared with findings at discharge, with no evidence of recurrence. Conclusions Diabetes mellitus complicated by severe DKA is an important warning sign for pulmonary mucormycosis in children. Early recognition and prompt initiation of antifungal therapy can significantly improve prognosis. For patients presenting with hemoptysis and obvious localized vascular involvement, active surgical debridement is beneficial in reducing mortality. A comprehensive management strategy incorporating rapid diagnosis and multidisciplinary collaboration should be established for this high-risk population.

Key words: diabetes mellitus, mucormycosis, lung diseases, fungal, prognosis, child