A diabetic patient on immunosuppressants develops black eschar on the nasal bridge with periorbital edema, proptosis, and visual loss. CT scan shows sinus involvement with orbital extension. The diagnostic test of choice and drug of choice are:
- A Tissue biopsy showing broad aseptate hyphae with right-angle branching — liposomal amphotericin B ✓
- B KOH mount showing septate hyphae — voriconazole
- C Blood culture showing Candida spp. — fluconazole
- D Skin biopsy showing sclerotic cells — itraconazole
Correct answer: A. Tissue biopsy showing broad aseptate hyphae with right-angle branching — liposomal amphotericin B
Explanation
Rhinocerebral mucormycosis (caused by Mucor, Rhizopus, Cunninghamella — Mucorales) presents as described, particularly in diabetic ketoacidosis. Histopathology shows characteristic broad (10-20µm), aseptate/pauci-septate hyphae with irregular right-angle (90°) branching and angioinvasion. DOC is liposomal amphotericin B (4-6mg/kg/day) plus surgical debridement. Voriconazole covers Aspergillus (septate 45° branching) but has no activity against Mucorales. Sclerotic cells suggest chromoblastomycosis.
Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.