Peer-reviewed veterinary case report
Cat with widespread histoplasmosis treated with posaconazole then
By Farber-Klein, Maia V & McQuinn, Erin R·Published in Journal of the American Veterinary Medical Association·2024·View original on PubMed →
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Original publication title: Posaconazole followed by combination itraconazole and terbinafine for treatment of disseminated histoplasmosis in a cat.
- Species:
- cat
Plain-English summary
A 1-year-old female spayed domestic longhair cat was brought in for severe weight loss, swollen lymph nodes, fluid in the abdomen, and skin nodules after being diagnosed with disseminated histoplasmosis (a fungal infection) six months earlier. Previous treatments with fluconazole and itraconazole had not worked, so the vet started her on posaconazole along with prednisolone. The cat showed significant improvement, but due to potential toxicity from the posaconazole, it was stopped. The cat's symptoms returned, but after switching to a combination of itraconazole and terbinafine, she was doing well at her last check-up and no longer showed signs of the infection.
People also search for: cat weight loss treatment · cat skin nodules · histoplasmosis treatment in cats · itraconazole for cats · posaconazole side effects in cats
Abstract
OBJECTIVE: This is the first reported use of posaconazole for the treatment of feline disseminated histoplasmosis. ANIMALS: Approximately 1-year-old female spayed domestic longhair cat. CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES: The cat presented to our institution with weight loss, lymphadenomegaly, hepatosplenomegaly, limb edema, abdominal fluid distension and ulcerated cutaneous nodules. The cat had been previously diagnosed with disseminated histoplasmosis at another institution approximately 6 months prior. Clinical signs had been refractory to treatment with fluconazole. Itraconazole had next been tried, and the cat's weight continued to decline, lesions failed to regress, and the cat formed abdominal fluid distension and marked pelvic limb edema. TREATMENT AND OUTCOME: The cat was prescribed posaconazole along with prednisolone. The cat's demeanor, body weight, and lesions all markedly improved. Histoplasma antigen was undetectable in urine samples while the cat was receiving posaconazole. However, posaconazole blood levels paired with markedly elevated ALT suggested potential toxicity and the drug was discontinued. Upon cessation of posaconazole, the cat's lesions returned with cytologic evidence of intralesional Histoplasma yeast. Itraconazole combine with terbinafine was prescribed. At last follow-up, the cat was clinically well, off all anti-fungal medication, and without detectable Histoplasma antigen in the urine. CLINICAL RELEVANCE: Posaconazole therapy showed promise in this case. Had a safe and therapeutic dose been arrived at, we suspect that posaconazole would have cleared or maintained clinical remission of this cat's disease. This is the first report using posaconazole and the first successful report using combination itraconazole and terbinafine for the treatment of feline disseminated histoplasmosis. Generic drugs were used throughout this case report; the drug manufacturers are unknown to the authors.
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Search related cases →Original publication on PubMed: https://pubmed.ncbi.nlm.nih.gov/38324995/