Date: 26 November 2013
Nasal, sinus and orbital aspergillosis in a cat. The left nasal cavity and sinus were full of pus and debris and there was severe bone erosion from the nasal cavity into the rostromedial orbitthrough which pus was protruding
Copyright:
(Kindly provided by Martin L. Whitehead, BSc, PhD, BVSc, CertSAM, MRCVS & Peter W. Kettlewell, BVSc, MSc, MRCVS. Chipping Norton Veterinary Hospital, Albion Street, Chipping Norton, Oxon, OX7 5BN.)
Notes:
History : Nasal aspergillosis is relatively common in dogs but rare in cats. Our veterinary hospital in Oxfordshire was recently presented with a 13-year old female Burmilla cat with a history of left-side unilateral nasal discharge, a watery left eye with slight blepharospasm, occasional ‘twitching movements’ of the head, weight loss, inappetance and depression. Clinical examination was unremarkable except for left-side mucopurulent nasal discharge, left-side mild serous ocular discharge, and a soft subcutaneous swelling over the left frontal sinus. Haematology, blood biochemistry and urinalysis revealed diabetes mellitus but was otherwise unremarkable. Radiography under general anaesthesia revealed a diffuse soft tissue density within the left nasal cavity and left frontal sinus. Rhinoscopy revealed mucopurulent discharge on the left side but was otherwise unremarkable. Aspiration of the swelling over the left frontal sinus produced pus and this abscess was lanced and flushed. The frontal sinus was trephined and the sinus and nasal cavity flushed with saline. Tests for feline immunodeficiency virus and feline leukaemia virus and serology for Aspergillus were not carried out. The cat was started on insulin, ibafloxacin (Ibaflin, Intervet) and meloxicam (Metacam, Boehringer). Cytology of the material flushed from the frontal sinus and nasal cavity revealed fungal hyphae consistent with Aspergillus species and culture of this material yielded growth of a fungus which was morphologically similar to A. candidus (Awaiting molecular typing results). The cat was then started on oral itraconazole (Itrafungol, Janssen) 10 mg/kg p.o. SID. The abscess over the rostral frontal sinus did not heal and a second abscess appeared over the nasal bone just dorsal to the nose. Infusion of the frontal sinus and nasal cavity with topical antifungal medication was discussed with the owners, but as the cat was deteriorating they requested euthanasia. On post-mortem examination the right nasal cavity, frontal sinus and orbit were unaffected. The left nasal cavity and sinus were full of pus and debris and there was severe bone erosion from the nasal cavity into the rostromedial orbit through which pus was protruding. There was also severe bone erosion rostrally through the nasal bone and less severe bone erosion dorsally over the rostral part of the frontal sinus, these sites of bone erosion being at the location of the two subcutaneous abscesses.Feline nasal aspergillosis is extremely rare in the UK and to our knowledge this is the first reported case of orbital aspergillosis in the UK although nasal aspergillosis has been reported in other countries.
Images library
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Yamik catheter for rinsing nasal and paranasal cavities. Image B
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Yamik catheter for rinsing nasal and paranasal cavities. Image E
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Patient with allergic fungal sinusitis. Eosinophilic mucin with A. flavus in the nasal cavity. Irregular crust of 2.5 cm from a patient diagnosed as allergic fungal sinusitis.
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This patient was diagnosed with Myelodyspasia/ Acute Myeloid Leukaemia in January 05. When he received intensive chemotherapy. Had previous history of chronic sinusitis, but after chemotherapy he developed significant maxillary sinusitis. He was treated with Caspofungin with good response, and subsequently with voriconazole. Patient has further CT scans in August 05 with myelodysplasia in remission.
A biopsy of ethmoid sinus in May showed a chronic inflammmatory process with bony invasion by fungal hyphae. The patient was in remission from myelodysplasia and was not undergoing treatment for this at the time of the scans.
In Aug 05 scans show the right maxillary sinus is now opacified. Destruction of superior medial wall of right maxillary sinus. Superiorly there was bone destruction with communication with the lower right ethmoid air cells. Lateral wall of right maxillary sinus remains thick walled with irregular periosteal thickening. No significant abnormality is seen within the nasal cavity or left paranasal sinuses. The biopsy of the ethmoid sinus revealed hyphae consistent with aspergillus. Since the patient was on voriconazole at this time this may indicate resistance. The case is ongoing with further surgery for debridement of right nasal side imminent. The patient is currently in remission.
Feb 06 D Denning
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This 33 year old woman with severe asthma since childhood and recent nasal obstruction, who did not fulfil the criteria for ABPA, had evidence of skin test sensitisation to Aspergillus. Itraconazole therapy orally improved her pulmonary symptoms and allowed a substantial reduction in the need for oral steroids and inhaled steroids. Nasal polyposis improved slightly, but she still required polypectomy and nasal steroids.
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Further details
Image A. The bone appears normal, but the features are most consistent with infection, less so with a pseudotumour. Bone windows not shown. Biopsy demonstrated hyphal invasion and cultures grew A. fumigatus.
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