A 58-year-old man with uncontrolled diabetes mellitus develops rhino-orbital mucormycosis confirmed on biopsy showing broad aseptate hyphae with angioinvasion. Along with immediate control of hyperglycemia and correction of ketoacidosis, what is the mainstay of definitive management?

• A Liposomal amphotericin B combined with aggressive surgical debridement ✓
• B High-dose oral voriconazole alone for six weeks
• C Oral itraconazole with serial imaging follow-up only
• D Intravenous fluconazole followed by elective endoscopic clearance after stabilization

Explanation

Mucorales are uniformly resistant to voriconazole, fluconazole and itraconazole, so liposomal amphotericin A remains first-line systemic therapy and must be paired with radical debridement of all necrotic tissue because angioinvasion produces infarction that antifungals cannot penetrate. Delaying surgery until stabilization worsens mortality. Voriconazole is actually the drug of choice for aspergillosis, not mucormycosis.

Reference: Katzung's Basic and Clinical Pharmacology, 15th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.