WBR0203

Author	[[PageAuthor::Ayokunle Olubaniyi, M.B,B.S [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Microbiology
Sub Category	SubCategory::Endocrine, SubCategory::Infectious Disease
Prompt	[[Prompt::A 40 year old male was rushed in unconscious to the ER after his wife found him. Laboratory studies revealed a pH of 7.10 and the serum was positive for ketones. He was subsequently treated for diabetic ketoacidosis and his condition improved. On day three, he developed fever, headache and eye pain. Examination of the nasal cavity revealed a black necrotic eschar. Which of the following is needed to make a diagnosis.]]
Answer A	AnswerA::Presence of pseudohyphae
Answer A Explanation	AnswerAExp::Presence of pseudohyphae is a feature seen in Candida albicans infection
Answer B	AnswerB::Broad non-septate hyphae with right angled branching
Answer B Explanation	AnswerBExp::Broad non-septate hyphae with right angled branching is a feature seen in mucormycosis
Answer C	AnswerC::Septate hyphae with V-shaped branching
Answer C Explanation	AnswerCExp::Septate hyphae with V-shaped branching is a feature seen in Aspergillus infections.
Answer D	AnswerD::Oval yeast cells within macrophages
Answer D Explanation	AnswerDExp::Oval yeast cells within macrophages is commonly is a feature commonly seen in histoplasmosis.
Answer E	AnswerE::Broad-base budding
Answer E Explanation	AnswerEExp::Broad-base budding is a pathognomonic feature seen in blastomycosis.
Right Answer	RightAnswer::B
Explanation	[[Explanation::Fever, headache and facial pain in a diabetic patient with diabetic ketoacidosis is highly suggestive of Mucormycosis – caused by Mucor, Rhizopus and Absidia. Rhizopus has a high affinity for ketones, and the black necrotic eschar in the nasal cavity is a characteristic finding. These fungi show broad non-septate hyphae with right angled branching. Treatment consists of surgical debridement and amphotericin B. Educational Objective: Fever, headache and facial pain in a diabetic patient with an uncontrolled blood sugar is highly suggestive of mucormycosis. It is treated with amphotericin B following a surgical debridement. References: First Aid 2014 page 148]]
Approved	Approved::No
Keyword	WBRKeyword::Diabetic ketoacidosis, WBRKeyword::mucormycosis
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::