Nonose, an intact male community cat in United States estimated to be somewhere between 3 and 5 years of age, had a slowly progressive facial lesion and audible respiratory noise of 1 year’s duration, based on reports by his community caretakers. The facial lesion was described as alternating between a visibly encrusted or an open bleeding wound. According to local community members, Nonose had been in the area for years; he had no known owner, and multiple caretakers provided him food but were never able to handle him. Nonose was able to be trapped and transported to a local clinic to assess the nature and extent of his disease.
On visual examination, Nonose was bright and alert, with severe respiratory stertor and subjectively increased inspiratory effort. No open-mouth breathing was noted during transport or at the clinic. He had a large lesion extending from the medial canthi across the forehead to just dorsal to the margin of the upper lips.
Nonose was anesthetized for further examination. The surface of the lesion was characterized by a glistening, serosanguinous, gelatinous material, which, when wiped with gauze, revealed exposed bone or cartilage. The full-thickness lesion extended into the mouth and through the upper left lip, creating a hole into the oral cavity.
Cryptococcal infections are seen worldwide in various species. Basidiospores are usually found in soil or avian fecal material; infection often occurs through inhalation but can occur via direct contact of basidiospores in open wounds.Incubation can range from a few months to years.
In cats, cryptococcosis is generally chronic and often presents as mucosal lesions in the nasal cavity. The glistening, serosanguinous gelatinous nature of the mass observed in this patient is a characteristic feature of cryptococcosis and a reflection of the presence of the polysaccharide capsule.
Once cryptococcosis is diagnosed, a discussion should be held with the owner regarding the cost of long-term medication and laboratory monitoring, the importance of owner and patient compliance for long-term oral therapy, and the potential for disease recurrence, particularly if compliance is poor. A committed owner and a compliant patient are essential for a successful outcome.
Due to the severity of facial tissue destruction, poor prognosis, and feral nature of the cat, euthanasia was elected.
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