A diabetic patient with poorly controlled diabetes develops proptosis, ophthalmoplegia, and black necrotic eschar over the nasal bridge and hard palate after a dental procedure. Tissue biopsy shows broad, pauci-septate (aseptate) hyphae with wide-angle branching. The most appropriate treatment is:
- A Voriconazole 6 mg/kg IV 12-hourly + aggressive surgical debridement
- B Micafungin 150 mg IV daily with conservative management
- C Itraconazole 200 mg twice daily orally
- D Liposomal amphotericin B 5–10 mg/kg/day IV + aggressive surgical debridement + glycaemic control ✓
Explanation
Rhino-orbital-cerebral mucormycosis (ROCM) is caused by Mucorales (Rhizopus, Mucor, Cunninghamella) and characteristically shows broad, pauci-septate or aseptate hyphae branching at wide (>90°) angles — distinguishing them from Aspergillus (narrow, septate, acute-angle branching). Treatment requires: liposomal amphotericin B (5–10 mg/kg/day, higher dose than conventional aspergillosis), aggressive surgical debridement of necrotic tissue, and reversal of the predisposing condition (diabetic ketoacidosis). Mucor is intrinsically resistant to voriconazole. Echinocandins have no activity against mucormycetes.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.