A diabetic patient on immunosuppressants develops acute-onset unilateral facial pain, periorbital swelling, and a black eschar on the middle turbinate. CT shows bony erosion of the medial orbital wall. The most likely organism and the appropriate first-line treatment are:

• A Aspergillus fumigatus; oral itraconazole
• B Mucor (Rhizopus) species; liposomal amphotericin B plus urgent surgical debridement ✓
• C Candida species; intravenous fluconazole
• D Fusarium species; voriconazole alone

Explanation

Acute invasive fungal rhinosinusitis (AIFRS) in immunocompromised or diabetic patients (diabetic ketoacidosis) is most commonly caused by Mucorales (Rhizopus, Mucor, Lichtheimia — zygomycetes). The hallmark is rapid tissue necrosis with a black eschar (angioinvasion causing infarction). Treatment requires urgent surgical debridement (radical endoscopic or open) combined with liposomal amphotericin B as first-line antifungal; correction of the underlying immunosuppression/hyperglycemia is essential. Azoles are ineffective against Mucorales except isavuconazole/posaconazole for salvage.

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.