Successful treatment of a sinonasal cryptococcal granuloma in a horse.

CASE DESCRIPTION A 12-year-old 500-kg (1,100-lb) American Quarter Horse mare was evaluated because of chronic mucopurulent, bloody discharge from the left nostril, inspiratory dyspnea, and respiratory noise. CLINICAL FINDINGS The horse had severe inspiratory dyspnea and stertorous respiration with no airflow from the left nostril. A temporary tracheostomy was performed. Endoscopy revealed a tan mass protruding from the left middle nasal meatus into the left common nasal meatus; it extended caudally into the nasopharynx and around the caudal edge of the nasal septum into the right nasal cavity. Radiographically, a soft tissue opacity was evident in most of the left nasal cavity and left paranasal sinuses. Cytologic examination of mass tissue revealed evidence of pyogranulomatous rhinitis; thickly encapsulated, budding yeast typical of Cryptococcus neoformans were detected. TREATMENT AND OUTCOME While the horse was sedated and in a standing position, the fungal granuloma was removed from the paranasal sinuses. Treatment with fluconazole (5 mg/kg [2.27 mg/lb], PO, q 24 h for 4 weeks) was initiated; enilconazole (50 mL of a 10% solution) was instilled into the paranasal sinuses every other day (7 lavages). Six weeks after surgery, infection had not recurred and epithelialization appeared normal in the left paranasal sinuses. CLINICAL RELEVANCE In horses with cryptococcosis of the paranasal sinuses, surgical removal of granulomatous lesions and systemic and topical administrations of antifungal drugs may be curative. Successful surgery may be performed in standing horses. Concommitant removal of a large portion of the conchae allows follow-up rhinoscopic evaluation of the paranasal sinuses.

[1]  F. Cabañes,et al.  Criptococosis y animales de compañía , 2008 .

[2]  J. C. Higgins,et al.  Treatment of Coccidioides immitis pneumonia in two horses with fluconazole , 2006, Veterinary Record.

[3]  C. Clercx,et al.  Surgical treatment of canine nasal aspergillosis by rhinotomy combined with enilconazole infusion and oral itraconazole. , 2006, The Journal of small animal practice.

[4]  J. Lane,et al.  Modified frontonasal sinus flap surgery in standing horses: surgical findings and outcomes of 60 cases. , 2010, Equine veterinary journal.

[5]  F. D. D. L. Corte,et al.  Criptococose pulmonar granulomatosa em um eqüino , 2005 .

[6]  R. Malik,et al.  Successful treatment of cryptococcal pneumonia in a pony mare. , 2004, Australian veterinary journal.

[7]  J. Schumacher,et al.  Treatment of conidiobolomycosis with fluconazole in two pregnant mares. , 2004, Journal of veterinary internal medicine.

[8]  J. Saunders,et al.  Intranasal infusion of enilconazole for treatment of sinonasal aspergillosis in dogs. , 2002, Journal of the American Veterinary Medical Association.

[9]  K. Hnilica,et al.  Evaluation of topically applied enilconazole for the treatment of dermatophytosis in a Persian cattery. , 2002, Veterinary dermatology.

[10]  P. M. Dixon,et al.  A long-term study of 277 cases of equine sinonasal disease. Part 2: treatments and results of treatments. , 2010, Equine veterinary journal.

[11]  M. Papich,et al.  Pharmacokinetics of fluconazole following intravenous and oral administration and body fluid concentrations of fluconazole following repeated oral dosing in horses. , 2001, American journal of veterinary research.

[12]  J. Schumacher,et al.  Paranasal sinus surgery through a frontonasal flap in sedated, standing horses. , 2000, Veterinary surgery : VS.

[13]  C. Greene Infectious Diseases of the Dog and Cat , 1990, Australian Veterinary Journal.

[14]  E. Johnson,et al.  In-vitro susceptibility of Cryptococcus neoformans isolates to fluconazole and itraconazole. , 1998, The Journal of antimicrobial chemotherapy.

[15]  J. Schumacher,et al.  Nasopharyngeal conidiobolomycosis in a horse. , 1996, Journal of the American Veterinary Medical Association.

[16]  A. Legendre,et al.  Successful treatment of guttural pouch mycosis with itraconazole and topical enilconazole in a horse. , 1994, Journal of veterinary internal medicine.

[17]  P. Y. Wan,et al.  Treatment of mycotic rhinitis with itraconazole in three horses. , 1994, Journal of veterinary internal medicine.

[18]  B. McGorum,et al.  A review of ten cases of equine mycotic rhinitis , 1992 .

[19]  C. Greene,et al.  Evaluation of ketoconazole and itraconazole for treatment of disseminated cryptococcosis in cats. , 1990, American journal of veterinary research.

[20]  R. Cox Immunology of fungal diseases. , 1989, Immunology series.

[21]  L. Evans,et al.  Nasal Amyloidosis in Four Horses , 1987, Veterinary pathology.

[22]  P. Dixon Equine respiratory medicine and surgery. , 1987, Equine veterinary journal.

[23]  J. Schmitz,et al.  Cryptococcal pneumonia in a horse. , 1983, Journal of the American Veterinary Medical Association.

[24]  M. C. Roberts,et al.  A protracted case of cryptococcal nasal granuloma in a stallion. , 1981, Australian veterinary journal.

[25]  J. Timoney,et al.  Hagan and Bruner's infectious diseases of domestic animals. , 1981 .

[26]  J. Duncan,et al.  Cryptococcosis involving the postorbital area and frontal sinus in a horse. , 1974, Journal of the American Veterinary Medical Association.

[27]  D. Watt A case of cryptococcal granuloma in the nasal cavity of a horse. , 1970, Australian veterinary journal.