A middle aged woman presents with black nasal discharge, right globe fixation and proptosis. Investigations reveal elevated blood sugar and positive urinary ketones. What is the appropriate therapy for this condition?: (A) Amphotericin, (B) Itraconazole, (C) Broad spectrum antibiotic, (D) Ketoconazole
Answer is A. Ref: Harrison's Principles of Internal Medicine, 18th edition, Pages 1661-1664Explanation:RHINOCEREBRAL MUCORMYCOSISCaused by the fungus Khizopus oryzae of Mucorales family.Causes infection in high risk groups:o Diabetics with DKA.o Defects in phagocyte function like neutropenics.o Glucocorticoid therapyo High free iron levelso ESRD on desferoxamine.Clinical Featureso Eye and facial paino Soft tissue swelling.o Extends to orbit - Proptosis. Chemosis, Ophthalmoplegia - Cavernous sinus thrombosis.o Infected tissue becomes edematous--Black necrotic eschar.o Pulmonary mucormycosis develops in leukemic patients on chemotherapy, o Lobar consolidation. cavitation, hemoptysis.o Other sites--Cutaneous. GIT.Biopsy--Thich ribbon-like hyphae which branch at right angles.DOC: Amphotericin B [Liposomal AmB less nephrotoxic |.Others: Capsofungin, Micafungin, Anidulafungin.