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Case Report: Successful Management of a Compressive Intraspinal Coccidioides Species Granuloma in a Cat.

ABSTRACT: A 9-year-old, neutered male, domestic shorthair cat from Arizona, was presented for evaluation of a 7-day history of hind limb paraparesis that progressed to paraplegia. There was no history of respiratory abnormalities. Neurologic examination supported localization of a T3-L3 myelopathy. Computed tomography (CT) revealed an expansile widening of the spinal canal dorsal to L4 associated with a strongly contrast-enhancing mass. Moreover, CT series of the thorax revealed a diffuse miliary pulmonary pattern, as well as tracheobronchial, sternal, and cranial mediastinal lymphadenomegaly. Transthoracic lung lobe and sternal lymph node fine needle aspiration revealed pyogranulomatous inflammation with Coccidioides spp. spherules and endospores. A suspected diagnosis of spinal coccidioidomycosis was made; fluconazole (10.9 mg/kg PO q12h) treatment was initiated, and decompressive neurosurgery was performed. The granuloma was removed en bloc and histopathology revealed marked, chronic-active, pyogranulomatous myelitis with intralesional Coccidioides spp. spherules with endosporulation. Serum anti-Coccidioides spp. antibody titer results revealed a negative IgM and a positive IgG (1:4). The cat was treated with fluconazole for 445 days and examined at various time points, with the last examination 2 years after initial presentation. The cat returned to full ambulation with only mild functional deficits of the right hind limb. In conclusion, this report documents the diagnosis, treatment, and long-term follow up of a cat with a compressive Coccidioides spp. spinal cord granuloma. This case highlights the importance of including coccidioidomycosis as a differential diagnosis for cats with peracute hindlimb paraplegia that have lived in or traveled to regions where Coccidioides spp. is endemic, and demonstrates the potential for a good long-term outcome with decompressive neurosurgery and antifungal therapy.

SUBMITTER: Dowdy H

PROVIDER: S-EPMC8757464 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundPenetrating thoracic injury is a type of critical illness with a high mortality rate, which often involves the heart, large blood vessels, and lungs. Penetrating cardiac injury is a very serious condition, and most patients die rapidly within minutes due to hemorrhagic shock and acute cardiac tamponade. Due to the critical condition and rapid development of this type of injury, most patients die before reaching the hospital. It is rare in clinical practice and difficult to treat.Case descriptionOur hospital recently admitted a case of penetrating cardiac injury. In this case, a 50-year-old male was admitted to the hospital following "a fall from a height [that] caused steel bar[s] to penetrate the chest cavity for 7 hours before he arrived at the hospital". The patient fell from a height of 3meters at a construction site, which caused 2 steel bars to penetrate his chest. The patient presented with symptoms such as chest pain, dyspnea, and apathy. Chest computed tomography suggested combined cardiopulmonary penetrating injury. Echocardiography suggested penetrating cardiac injury, and moderate pericardial effusion. After the patient was sent to the Emergency Department of our hospital, the relevant laboratory examinations and an emergency surgery were performed. The rescue team consisting of cardiac surgery, thoracic surgery, anesthesiology, emergency department, and imaging department specified the treatment plan. Under general anesthesia, cardiopulmonary bypass was performed via right femoral arteriovenous cannulation. The steel bars were removed, the left atrial posterior wall and ventricular septal perforation were repaired, and the great cardiac vein was sutured. Coronary artery bypass surgery was performed at the same time, and the anterolateral lung tissue of the left lower lobe was resected. Postoperative treatment was given to prevent against infection and improve cardiopulmonary function. The patient recovered well, and he was discharged from the hospital. The results of the follow-up 1 year after surgery were normal.ConclusionsTimely treatment and a reasonable operation mode is essential in treating this kind of trauma. A joint diagnosis and treatment by a multidisciplinary team can enable a comprehensive assessment of the condition to be made quickly and an optimal treatment plan to be formulated.

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Case Report: Successful Management of a Compressive Intraspinal Coccidioides Species Granuloma in a Cat.

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