A 55-year-old diabetic male presents with progressive unilateral nasal obstruction, periorbital oedema, ptosis, and reduced vision. CT shows bony destruction of the medial orbital wall and roof of ethmoid. Biopsy shows aseptate hyphae with right-angle branching. The most critical prognostic determinant in this condition is:
- A Duration of nasal symptoms before diagnosis
- B Surgical clearance of necrotic tissue combined with control of underlying immunosuppression ✓
- C Species of Mucor identified
- D Presence of nasal polyps
Correct answer: B. Surgical clearance of necrotic tissue combined with control of underlying immunosuppression
Explanation
This presentation describes rhino-orbital-cerebral mucormycosis (ROCM) — a rapidly fatal, angio-invasive fungal infection caused by Mucorales (broad, aseptate hyphae with wide-angle/irregular branching). It occurs in diabetics (especially with DKA) and immunocompromised patients. The two critical determinants of survival are: rapid and aggressive surgical debridement of all necrotic tissue (to reduce fungal burden) and reversal/control of the underlying immunosuppression (correction of DKA, reduction of steroids). IV liposomal amphotericin B is the antifungal of choice.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.