Cats sneeze, and often it is hard to know whether sneezing warrants medical attention. Almost every day I see patients who sneeze and are congested. Most sneezing is due to mild upper-respiratory infections, but sometimes it is due to something more serious.

Two weeks ago I met Kasey, an 11-year-old domestic shorthair cat. He had been having sneezing and nasal congestion for a few weeks, and he had a red growth protruding from his right nostril. He had been a healthy, indoor cat until recently. Kasey’s owners brought him to my clinic for a second opinion after an initial treatment with oral antibiotics did not improve his condition.

Kasey’s owners said at first it looked like he had a scratch on his nose, but swelling and a filling of his right nostril with red tissue had occurred. The two other cats that Kasey lived with did not have any similar issues. Kasey recently had been sleeping more and was generally more lethargic. The upper nose was swollen and looking deformed, too.

I discussed likely possible diagnoses with his owner. These included a bacterial infection, fungal infection, viral infection or tumor . Since the lesion in his right nostril was growing rapidly, I thought a fungal infection most likely, with a tumor second most likely. His owner agreed to biopsies of the right side of his nose, and I performed them later that day. Kasey went home and we received the pathology report a couple of days  later.

Biopsies revealed a fungal infection, Cryptococcus neoformans, was the cause of Kasey’s nasal issues. Cryptococcus is a fungus that is found in bird droppings and soil contaminated by the droppings. It is frequently found in Southern California. Infections typically arise when a cat inhales the fungal spores from the environment. The fungus can spread from the respiratory tract to the central nervous system, eyes, lungs and other tissues. Cats are more susceptible to infection than dogs. The fungus can affect humans but is most threatening to people with compromised immune systems. Although Kasey stayed exclusively indoors, he likely was exposed from someone tracking in spores on their shoes. There would not have been any way to prevent his infection.

Kasey was started on an oral anti-fungal drug called fluconazole. He will be rechecked in two weeks and then every other month if treatment is going well. Getting rid of a Cryptococcus infection can take six months or longer. We will use blood tests and physical exams to monitor his response to treatment.

We see four to six cases of Cryptococcus per year at my practice. Currently we are treating five patients with Cryptococcus. One other cat had upper respiratory disease, one had a skin lump on his side, one had enlarged lymph nodes in his neck, and the last cat had a lump on his anus. Four of the cases were diagnosed with biopsies. One cat was diagnosed with a blood test.

Cryptococcus needs to be considered as a possible diagnosis in cases of chronic upper respiratory disease, especially if there is swelling of the bridge of the nose, deformity of the nose or any type of growth or tissue protruding from the nostrils. I hope Kasey will tolerate his fluconazole and be easy for his owners to medicate. If so, I expect a successful outcome within six months.

Written by Dr. Wexler-Mitchell of The Cat Care Clinic in Orange, CA
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