(BMJ)—A woman in her 50s with hx of uncontrolled DM presented with nasal obstruction and right facial pain. She was treated empirically for sinusitis, with nasal steroids and saline wash. Ten days later, she presented to the ED, with a black paranasal lesion. What’s the dx?
Cutaneous anthrax
Sinonasal sarcoma
Ecthyma gangrenosum
You are correct. Invasive fungal infection was suspected because of the characteristic black appearance of the lesion. Dx was confirmed by isolation of Rhizopus arrhizus from a bx sample. The patient underwent immediate emergency surgery for debridement, and systemic antifungal tx was started.

Acute invasive rhino-orbito-cerebral mucormycosis is a life-threatening fungal infection that occurs in patients who are immunocompromised, such as those with poorly controlled DM (70% of cases). Other predisposing factors include hematological neoplasms, renal transplant, injection drug use, and use of deferoxamine.

Because of the rapid progression of this condition, early surgical debridement is imperative to avoid extensive tissue and eye loss and even death.

BMJ 2021;374:n1705