A 45-year-old woman with poorly controlled diabetes (HbA1c 11.2%) presents with severe frontal headache, proptosis, and black necrotic tissue involving the nasal turbinate and palate. Vital signs show BP 148/92, HR 102, RR 18, Temp 38.5°C, SpO2 98% on room air. MRI demonstrates invasion into the paranasal sinuses and frontal lobe. Blood glucose is 385 mg/dL. She denies recent nasal trauma. Which of the following is the most appropriate initial intervention?
- A)Oral fluconazole monotherapy
- B)IV ceftriaxone and vancomycin
- C)Urgent surgical debridement combined with IV amphotericin BGABARITO
- D)Observation with repeat imaging in one week
- E)Topical miconazole applied directly to lesions
Explicação
This patient has rhinocerebral mucormycosis, an angioinvasive infection in diabetics. Urgent surgical debridement combined with IV amphotericin B is required to prevent mortality. The aggressive vascular invasion leads to tissue necrosis and rapid disseminatio... Ver explicação completa e trilha adaptativa →