Spinal Mucormycosis Following a Traditional Cupping Procedure in a Diabetic Patient: A Rare Case Report from Somalia.

Background: Spinal mucormycosis is a rare but potentially fatal fungal infection that is often observed in immunocompromised patients, particularly in those with poorly controlled diabetes or other systemic conditions. Early diagnosis and treatment are crucial for improving patient outcomes. Case Presentation: A 55-year-old male with poorly controlled diabetes mellitus presented with throat pain, chest tightness, and dyspnea. Over the course of one year, the patient experienced repeated hospitalizations for pneumonia and pleural effusion, and subsequently developed a spinal abscess following a traditional cupping procedure. Imaging revealed severe spinal cord compression and abscess formation, extending from the thoracic spine. Initial treatment with antibiotics did not yield a significant improvement, and further imaging suggested possible tuberculosis. However, histopathological examination after thoracic spinal laminectomy confirmed the presence of mucormycosis. Management: The patient was initially started on empiric intravenous fluconazole, which was discontinued upon confirmation of mucormycosis. Definitive therapy with intravenous liposomal amphotericin B was then initiated, along with broad-spectrum intravenous antibiotics for possible secondary bacterial infection. Thoracic spinal laminectomy was performed; however, despite treatment, no recovery from paraplegia was observed, and the patient was discharged after several months of care. Discussion: Mucormycosis can present insidiously, mimicking bacterial or tuberculous infections, making early diagnosis difficult. In this case, delayed identification and treatment of the fungal infection allowed it to spread, leading to severe complications. The importance of maintaining a high index of suspicion for fungal infections in immunocompromised individuals is emphasized, particularly when standard therapies fail. Conclusion: Spinal mucormycosis is a rare but serious condition that requires prompt diagnosis and aggressive management. This case underscores the need for early recognition and a multidisciplinary approach for managing infections involving both medical and surgical interventions. Timely initiation of antifungal therapy is critical for improving patient outcomes and reduce mortality.