A diabetic patient presents with a 5-day history of unilateral nasal obstruction, periorbital swelling, black eschar on the nasal mucosa, and proptosis. CT scan shows bone erosion of the medial orbital wall. The most critical immediate step in management is:

• A IV voriconazole and observation
• B IV amphotericin B and urgent surgical debridement ✓
• C Diagnostic nasal biopsy under local anaesthesia with antifungal awaiting culture
• D Broad-spectrum antibiotics and orbital decompression

Explanation

This is a classic presentation of acute invasive fungal sinusitis (mucormycosis), particularly in poorly controlled diabetics (rhinocerebral mucormycosis). Management requires simultaneous dual intervention: IV amphotericin B (liposomal preferred for reduced nephrotoxicity) AND urgent surgical debridement of all necrotic and infected tissue. Delay worsens mortality dramatically. Voriconazole is not effective against Mucor; waiting for cultures is dangerous given the rapidity of progression; antibiotics are insufficient as this is a fungal infection.

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.