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Complicated Sinusitis — SCE Infectious Diseases MCQ

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HardRespiratory InfectionComplicated SinusitisSCE Infectious Diseases

A patient in diabetic ketoacidosis develops rapidly progressive unilateral facial pain, proptosis, ophthalmoplegia, a black middle-turbinate eschar and sinus bony erosion. What should happen immediately?

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Correct answer: C — Urgent surgical debridement and tissue diagnosis plus immediate high-dose intravenous liposomal amphotericin B

This is rhino-orbital mucormycosis until proved otherwise. Outcomes depend on immediate treatment: urgent imaging to define extent, aggressive surgical debridement and tissue diagnosis, prompt high-dose liposomal amphotericin B, and reversal of ketoacidosis. Voriconazole lacks Mucorales activity. Broad-spectrum antibacterial therapy alone dangerously delays definitive care.

Reference: ECMM mucormycosis guideline: https://pmc.ncbi.nlm.nih.gov/articles/PMC8559573/