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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Late (venous) phase angiogram of a right intercostal artery showing persistence of vascular blush and further filling of a branch of the pulmonary artery.
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Catheter tip in a right posterior intercostal artery on screening film.
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Angiogram of a right bronchial artery on subtraction film in the early arterial phase showing filling hypervascular circulation superiorly and communications with a pulmonary arterial radical.
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This patient with severe pulmonary sarcoidosis has bilateral aspergillomas. A rim of air is visible around parts of the aspergillomas on both sides. This patient was recruited into the NIAID Mycoses Study Group multicentre study of the treatment of invasive pulmonary aspergillosis with itraconazole but not analysed because invasive disease was not demonstrated. Denning DW, Lee JY, Hostetler JS, Pappas P, Kauffman CA, Dewsnup DH, Galgiani JN, Graybill JR, Sugar AM, Catanzaro A, Gallis H, Perfect JR, Dockery B, Dismukes WE, Stevens DA, NIAID Mycoses Study Group multicenter trial of oral itraconazole therapy of invasive aspergillosis. Am J Med 1994; 97: 135-144
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Extensive pleural thickening is demonstrated at the left apex on this CT scan of a woman who had previously had tuberculosis and whose large cavity gradually became obliterated by pleural thickening. An aspergilloma is demonstrable within the cavity
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This chest radiograph (AMBER film) demonstrates the typical extensive pleural thickening at the right apex, seen in patients with aspergillomas. The cavity appears not to contain an aspergilloma but on CT scan had some ‘debris’ and Aspergillus antibiotics (precipitins) were strongly positive. The differential diagnosis lies between an aspergilloma and chronic invasive pulmonary aspergillosis. The extensive pleural thickening is heavily in favour of an aspergilloma, even without a well demonstrated fungal ball in the cavity.
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Image C. Another example of a severe apical aspergilloma with remarkably little pleural thickening on plain chest radiograph (AMBER film). Severe distortion of the trachea is demonstrated.
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Right apical aspergilloma, patient WC. Plain chest radiograph of patient with right apical aspergilloma in an old, large tuberculous cavity. Severe haemoptysis and respiratory insufficiency together constituted the indications for embolisation which was done in one session over a 3 hour period (see images 1-6).
