A 22-Year-Old Hospitalized Man Is Evaluated for New-Onset Fever

A 22-year-old hospitalized man is evaluated for new-onset fever.  The patient has a history of type 1 diabetes mellitus and came to the hospital 4 days ago due to abdominal pain, nausea, and vomiting.  Admission laboratory studies showed blood glucose of 450 mg/dL, positive urine ketones, and metabolic acidosis on arterial blood gas analysis.  He was treated with intravenous fluids and insulin infusion with improvement in his condition, and was transitioned to subcutaneous insulin.  Over the past 24 hours, he has had high fever, worsening headache, and nasal congestion.  Temperature is 38.9 C (102 F) , blood pressure is 130/80 mm Hg, and pulse is 110/min.  Mild periorbital swelling is present.  There is right-sided, bloody, purulent nasal discharge and a black eschar on the inferior nasal turbinate.  Percussion reveals a tender right-sided maxillary sinus.  Neurological examination is normal.  Which of the following is the best pharmacological treatment for this patient's current condition?

A) High-dose penicillin
B) Intravenous caspofungin
C) Intravenous voriconazole
D) Liposomal amphotericin B
E) Trimethoprim-sulfamethoxazole

Correct Answer:

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