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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Pt FT. Autopsy appearance of the trachea, after the adherent pseudomembrane had been removed, revealing confluent ulceration superiorly with small green plaques of Aspergillus growth on the trachea inferiorly.
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This view was obtained in a lung transplant recipient at bronchoscopy. Aspergillus fumigatus was grown from bronchial lavage but invasion was not demonstrated on bronchial biopsy. Symptoms improved with itraconazole therapy and abnormal appearances had resolved within 2 weeks.
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Bronchoscopic view of Aspergillus tracheobronchitis. Bronchial lavage revealed hyphae in microscopy and cultures grew A.fumigatus. This man had received a lung transplant a few weeks before. Invasion of mucosa, but not cartilage, was demonstrated histologically. He responded rapidly to oral itraconazole.
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This view from indirect laryngoscopy illustrates bilateral lesions on the larynx that on biopsy were shown to be due to Aspergillus. This is a rare disease in non-immunocompromised patients.
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Bronchoscopic view of a deep bronchial ulcer in a lung transplant patient. Biopsies through the ulcer yielded cartilage with hyphae invading it. Fungal cultures of bronchial lavage grew Aspergillus fumigatus. He responded to oral itraconazole therapy.
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Patient had life threatening pneumonia, cavity formation was later observed. He later presented with a fungal ball. The aspergilloma was removed by surgical resection of the right upper lobe.
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