A 55-year-old uncontrolled diabetic presents with fever, unilateral facial pain, proptosis, and black necrotic eschar on the nasal turbinate. Emergency nasal endoscopy reveals black discolouration of the middle turbinate. The most appropriate immediate management is:

• A Intravenous voriconazole and elective surgical debridement
• B Topical antifungal cream and systemic itraconazole
• C IV piperacillin-tazobactam and dexamethasone
• D Aggressive glycaemic control, IV liposomal amphotericin B, and emergency surgical debridement ✓

Explanation

This is acute invasive rhinosinusitis due to mucormycosis (Mucor or Rhizopus), a life-threatening opportunistic fungal infection in immunocompromised patients, particularly uncontrolled diabetics. The triad of management is: correct the underlying immunosuppression (aggressive glycaemic control), initiate liposomal amphotericin B as the drug of choice, and perform emergency extensive surgical debridement of all necrotic tissue. Voriconazole is ineffective against Mucor; it is used for Aspergillus.

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.