Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 36-1987. A 14-year-old girl with diabetic ketoacidosis and pneumonitis with cavitation

Pulmonary Mucormycosis

A 78-year-old diabetic man presented with consolidation in the middle and lower lobe of the right lung. An endobronchial mucoid mass was found to be obstructing the right middle lobe and right lower lobe bronchi. The patient was treated with intravenous amphotericin B followed by a right pneumonectomy. Histopathology of the resected specimen demonstrated broad nonseptate hyphae branching at right angles, characteristic of mucormycosis.

Respiratory failure in diabetic ketoacidosis

Respiratory failure complicating the course of diabetic ketoacidosis (DKA) is a source of increased morbidity and mortality. Detection of respiratory failure in DKA requires focused clinical monitoring, careful interpretation of arterial blood gases, and investigation for conditions that can affect adversely the respiration. Conditions that compromise respiratory function caused by DKA can be detected at presentation but are usually more prevalent during treatment. These conditions include deficits of potassium, magnesium and phosphate and hydrostatic or non-hydrostatic pulmonary edema. Conditions not caused by DKA that can worsen respiratory function under the added stress of DKA include infections of the respiratory system, pre-existing respiratory or neuromuscular disease and miscellaneous other conditions. Prompt recognition and management of the conditions that can lead to respiratory failure in DKA may prevent respiratory failure and improve mortality from DKA.