Correct!
2. Liposomal amphotericin B
Liposomal amphotericin B is the first line drug of choice if one is diagnosed with or even if there is a strong suspicion for mucormycosis. The liposomal formulation has been much better tolerated and less risk to the kidneys. Posaconazole may also be used, but this is not first line. Typically, this anti fungal agent is either a substitute for poor tolerance to amphotericin, or may be used as adjunctive therapy for mucormycosis. The other anti fungal agents listed have NO activity against mucoracae, except for micafungin, which has minimal activity against this fungus; but you would not employ this agent as it is only weakly effective and does not cure this fungal disease. Given its 100% fatality rate if untreated, one must use the appropriate therapy as mentioned.
Surgical resection, if feasible, is also considered first line, in particular with rhinocerebral mucormycosis, but there is limited evidence of benefit with invasive / disseminated disease.
Our patient may have benefited from early amphotericin, however, at the time we saw him in the ICU, this process had already disseminated, and thus likely was futile from the start. We failed to see the connection in his disease process, underlying immunocompromised state and the possibility for invasive / disseminated mucormycosis.
What would have been the best test to obtain a positive diagnosis for mucormycosis and with best sensitivity? (Click on the correct answer to proceed to the fifth of five panels)