& x20;A diabetic patient presents with facial pain, black nasal eschar and eye pain following corticosteroid… - INI-CET EXAM -2026

INI-CET EXAM -2026

Applied Microbiology & Infection control

Easy

Appeared in: INI-CET EXAM -2026

Explanation

The patient's presentation with diabetes, facial pain, and a black nasal eschar is a classic sign of rhino-orbital-cerebral mucormycosis.
Rhizopus species are the most common cause of mucormycosis, an aggressive fungal infection.
This fungus is angioinvasive, meaning it invades blood vessels, causing thrombosis and tissue necrosis, which manifests as the black eschar.
Risk factors like diabetes mellitus (especially with ketoacidosis) and corticosteroid use create an ideal environment for Rhizopus to thrive.

Option A: Candida species, including C. tropicalis, typically cause mucocutaneous infections like oral thrush or systemic infections like candidemia (bloodstream infection), especially in patients with central lines or neutropenia. They do not cause black necrotic eschars in the sinuses.
Option B: Aspergillus fumigatus primarily causes respiratory infections, such as aspergilloma ('fungus ball') in pre-existing lung cavities or allergic bronchopulmonary aspergillosis (ABPA). While it can cause invasive sinusitis, the presentation with a rapidly progressing black eschar is far more characteristic of mucormycosis.
Option C: Cryptococcus neoformans is most famous for causing meningitis and pneumonia, particularly in individuals with severe immunosuppression, such as those with advanced HIV/AIDS. It does not present with rhino-orbital disease or black eschar.

Clinical Relevance

Nursing practice connection: Use the key finding related to Identification of the causative agent for rhino-orbital-cerebral mucormycosis based on clinical presentation and risk factors to guide bedside assessment, documentation, and the next nursing action.
Recognizing the triad of diabetes, immunosuppression, and black eschar is a critical nursing skill, as mucormycosis is a surgical and medical emergency with a high mortality rate.
Nursing priorities include rapid escalation to the medical team, preparing for emergency surgical debridement, and managing aggressive antifungal therapy (often Amphotericin B), which requires close monitoring for toxicity.
What if? If the patient was not diabetic but was severely neutropenic after chemotherapy and presented with similar symptoms, mucormycosis would still be the primary suspicion, as profound immunosuppression is a major risk factor.

How to Approach the Question

First, analyze the patient's profile and risk factors provided in the stem: 'diabetic' and 'corticosteroid therapy'. These point towards an immunocompromised state and a high-glucose environment, which favor opportunistic fungal infections.
Next, identify the most specific and defining clinical sign: 'black nasal eschar'. This is a highly characteristic finding.
Correlate the risk factors and the pathognomonic sign. The combination of diabetes and a black necrotic lesion in the sinuses strongly suggests angioinvasive fungal disease.
Evaluate the options. Consider which fungus is classically associated with this presentation. Rhizopus is the well-known agent of mucormycosis, which perfectly matches the clinical picture.
Eliminate the other options based on their typical presentations: Candida (thrush, candidemia), Aspergillus (lung balls, allergic reactions), and Cryptococcus (meningitis in HIV patients).

Concept Tested & Keywords

Concept Tested: Identification of the causative agent for rhino-orbital-cerebral mucormycosis based on clinical presentation and risk factors.
Stem keywords: diabetic patient, facial pain, black nasal eschar, eye pain, corticosteroid therapy
Lead-in keywords: etiological agent
Clinical cues: The combination of diabetes, corticosteroid use, and a black nasal eschar is pathognomonic for mucormycosis.

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