A 35-year-old poorly controlled diabetic presents with nasal congestion, blood-tinged discharge, and periorbital swelling. Nasal endoscopy shows black necrotic tissue over the middle turbinate. CT reveals destruction of medial orbital wall. The organism most likely responsible is:

• A Aspergillus fumigatus
• B Candida albicans
• C Mucor/Rhizopus species (Mucormycosis) ✓
• D Pseudomonas aeruginosa

Explanation

Acute invasive fungal sinusitis in a diabetic (especially with ketoacidosis) or immunocompromised patient with black necrotic nasal tissue and rapid bony destruction is characteristic of mucormycosis (Rhizopus, Mucor, Cunninghamella). Mucor has a predilection for blood vessel invasion causing thrombosis and tissue necrosis. Aspergillus causes a different form (chronic invasive or allergic fungal) without the acute fulminant necrotic pattern. Treatment requires urgent surgical debridement, IV amphotericin B, and control of the underlying immunosuppression.

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.