A 55-year-old diabetic patient presents with a 1-week history of left-sided facial pain, periorbital swelling, proptosis, and blood-stained nasal discharge. CT PNS shows hyperdense material in the left maxillary and ethmoid sinuses with erosion of the medial orbital wall. Emergency nasal endoscopy shows black eschar on the left inferior turbinate. What is the most likely causative organism and the immediate management priority?
- A Aspergillus fumigatus; systemic voriconazole
- B Pseudomonas aeruginosa; systemic antipseudomonal antibiotics
- C Mucor species (Rhizopus/Mucor/Cunninghamella); immediate surgical debridement + intravenous amphotericin B ✓
- D Aspergillus niger; systemic itraconazole plus FESS
Explanation
This presentation — diabetic ketoacidosis setting, rapid onset with orbital involvement, black eschar, hyperdense CT material with bone erosion — is classic for acute invasive rhinosinusitis caused by Mucorales (Rhizopus, Mucor, Cunninghamella spp.), collectively termed mucormycosis. The black eschar results from angioinvasion causing thrombosis and infarction of tissue. Immediate management requires simultaneous aggressive surgical debridement of all necrotic tissue AND intravenous liposomal amphotericin B plus reversal of the underlying immunosuppression (control of hyperglycemia). Voriconazole is ineffective against Mucorales and appropriate only 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.