A 60-year-old poorly controlled diabetic presents with black necrotic eschar on the nasal mucosa, periorbital swelling, and ophthalmoplegia. Biopsy shows broad, aseptate hyphae with right-angle branching and vascular invasion. What is the most appropriate immediate management?
- A Intravenous ceftriaxone and nasal packing
- B Oral voriconazole and observation
- C Intravenous amphotericin B and aggressive surgical debridement ✓
- D Topical nystatin and diabetic control alone
Correct answer: C. Intravenous amphotericin B and aggressive surgical debridement
Explanation
This is acute invasive fungal sinusitis (mucormycosis) in a diabetic ketoacidosis patient. The causative organism is Mucor/Rhizopus with broad, aseptate, ribbon-like hyphae showing right-angle branching and vascular invasion. This is a medical and surgical emergency with high mortality. Treatment requires immediate intravenous amphotericin B (liposomal preferred) and aggressive surgical debridement of all necrotic tissue. Oral voriconazole is used for aspergillosis, not mucormycosis.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.