A 52-year-old diabetic patient presents with left periorbital swelling, proptosis, ophthalmoplegia, and black necrotic turbinates following a week of poorly controlled hyperglycemia. CT scan shows destruction of the left medial orbital wall and ethmoid sinuses. KOH mount of nasal discharge reveals broad non-septate hyphae with right-angle branching. What is the NEXT most critical step in management?
- A Intravenous amphotericin B and urgent surgical debridement of necrotic tissue ✓
- B Start oral itraconazole and optimize blood sugar control
- C IV voriconazole and observation for 48 hours
- D Functional endoscopic sinus surgery to improve drainage only
Correct answer: A. Intravenous amphotericin B and urgent surgical debridement of necrotic tissue
Explanation
The presentation describes acute invasive rhinosinusitis due to Mucorales (mucormycosis) — broad non-septate hyphae with right-angle branching are characteristic, as opposed to Aspergillus (septate hyphae with acute-angle branching). Management requires simultaneous IV liposomal amphotericin B (first-line antifungal) and aggressive surgical debridement of all necrotic tissue, without delay. Voriconazole is not active against Mucorales. Oral itraconazole is inadequate. Drainage surgery alone is insufficient.
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.