Successful long-term therapy of mucormycosis with isavuconazole

We present a case of a 55-year-old poorly controlled diabetic who presented to the hospital with facial pain, ophthalmoplegia, vision changes, and diabetic ketoacidosis and was diagnosed with rhinocerebral mucormycosis due to Rhizopus microsporus. He was started on liposomal amphotericin B and micafungin and went for nasal endoscopy and debridement, but the infection had progressed through the base of the skull and he received the maximum tolerated debridement. Posaconazole was added and discontinued due to elevated liver chemistry tests and was replaced with oral isavuconazole. After 6 weeks of therapy with liposomal amphotericin B and isavuconazole, he was switched to oral isavuconazole monotherapy. He underwent 30 sessions of hyperbaric oxygen therapy. Imaging showed improvement with subsequent biopsies that were negative for mucormycosis. At 13 months of therapy, his monotherapy was discontinued. He continues to have long-term sequelae including left facial droop and inability to close his left eye.