DKA

A 30 male presented with shortness of breath of five days duration, fever of 5 days , altered sensorium of one day duration.got admitted in outside hospital evaluated and done ct chest found to have right lower lobe consolidation treated as pneumonia with iv tazact, azithromycin and fluvir. after 3 days of admission he had involuntary passage of micturition ct brain done normal found to have high sugars and in view of worsening short of breath referred to our hospital. at the time of admisssion patient is in altered sensorium , drowsy arousable to commands ,sugars are high vitals hr 110/min bp - 120/70 RR 30/MIN SPO2 - 98% ON room air. in the emergency room gave iv fluids and started on insulin infusion and shifted to ICU. after shifting to icu in view of ? doubtful cavitation in outside CT chest repeated CT chest, which showed cavatation increacse in size . in view of background of DKA suspected mucormycosis started empiricallly on liposomal amphotercin B, continued iv fluids intially with normal saline later switched to DNS, at the end of 24 hours he was cumulative positive by 6 liters and anion gap closed . For confirmation did bronchoscopy which showed mucor lesions and sent for BAL microbiology. Later mucor got involved chest and pericardium. in view of worsening situation CTVS consultation taken for pneumonectomy, which was done after 2 days , later he improved symptomaticslly and then got discharged. with posoconazole medication. on followup noticed pus discharge from chest drain started on zienem antibiotic in view of pus.