A 45-year-old diabetic male presents with proptosis, periorbital ecchymosis, loss of vision, and fever for 5 days after a COVID-19 infection. CT sinuses show opacification of the left maxillary and ethmoid sinuses with erosion of the medial orbital wall. Nasal endoscopy reveals black eschar on the turbinate. The most urgent intervention is:

• A IV voriconazole + FESS within 48 hours
• B IV amphotericin B + surgical debridement within 24 hours ✓
• C High-dose IV corticosteroids + broad-spectrum antibiotics
• D Exenteration of the orbit as first step to save life

Explanation

The presentation is consistent with acute invasive fungal sinusitis (Mucormycosis), confirmed by black eschar and bony erosion in an immunocompromised (diabetic) patient. The standard of care is immediate IV liposomal amphotericin B plus aggressive surgical debridement (often including endoscopic and open approaches) within 24 hours, as delay dramatically worsens mortality. Voriconazole is not active against Mucor; it is used for Aspergillus. Corticosteroids are contraindicated as they worsen 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.