Treating Nasal Aspergillosis—Intranasal Clotrimazole

This case report described nasal aspergillosis in 2 cats. The first case was a 13-year-old with diabetes mellitus, renal disease, and inflammatory bowel disease evaluated for nasal discharge and dyspnea with minimal response to antibiotics. Computed tomography (CT), retrograde rhinoscopy, and biopsies were performed. Bilateral turbinate destruction, nasal mucosal thickening, soft tissue densities, and white-gray plaques were noted. Histopathology revealed fungal rhinitis; Aspergillus niger was identified on fungal culture. The cat was anesthetized and treated with a nasal clotrimazole infusion for 1 hour. Its condition improved after this procedure and there were no clinical signs of disease 2 years later. The second case was an 11-year-old cat evaluated for a 5-month history of sneezing, congestion, and nasal discharge with minimal response to antibiotics. Skull radiographs revealed right nasal and frontal sinus opacities. Nasal flushes and normograde biopsy demonstrated rhinitis with Aspergillus species hyphae. Subsequent CT and rhinoscopy were performed; bilateral turbinate destruction, bony lysis, and soft tissue densities were seen throughout the right nasal cavity and frontal sinus with chronic active rhinitis. The cat returned 5 months later with minimal improvement. CT findings were unchanged, but the nasal flush yielded a brown exudate with branching fungal hyphae on cytology and Aspergillus species on fungal culture. Owner declined treatment and the cat returned in 3 months due to persistent signs. CT findings were similar to previous scans and clotrimazole was infused as previously described. The cat did well postoperatively with no signs of recurrence 4 years after the procedure.

COMMENTARY: Clotrimazole nasal infusions were an effective long-term treatment for feline nasal aspergillosis in this study, and should be considered as a potential therapeutic modality, particularly in cases with an intact cribriform plate on CT scans (which will diminish the likelihood of toxicity). There is a paucity of clinical data describing treatment for this condition, and case studies will contribute to the efforts to identify standard treatments for feline nasal aspergillosis.—Indu Mani, DVM, DSc (infectious disease)

Intranasal infusion of clotrimazole for the treatment of nasal aspergillosis in two cats. Furrow E, Groman RP. JAVMA 235:1188-1193, 2009.