A neutropenic patient post-chemotherapy develops right-sided facial swelling, black nasal eschar, and a right-sided ptosis. CT shows orbital involvement. KOH mount of the nasal tissue shows broad, non-septate, ribbon-like hyphae with wide-angle branching. The drug of choice is:
- A Voriconazole 6 mg/kg IV every 12 hours
- B Liposomal amphotericin B 5–10 mg/kg/day IV ✓
- C Caspofungin 70 mg loading dose IV
- D Itraconazole 200 mg oral twice daily
Correct answer: B. Liposomal amphotericin B 5–10 mg/kg/day IV
Explanation
The clinical picture is rhinocerebral mucormycosis (caused by Mucorales — Rhizopus, Mucor, Lichtheimia). KOH mount showing broad, non-septate (aseptate) ribbon-like hyphae with wide-angle (>90°) irregular branching is characteristic of Mucorales, differentiating it from Aspergillus (septate, 45° acute-angle branching). Liposomal amphotericin B at 5–10 mg/kg/day is the drug of choice; surgical debridement is equally essential. Voriconazole has NO activity against Mucorales. Caspofungin and itraconazole are also ineffective.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.