title: Multimodal treatment of recurrent sinonasal cryptococcal granulomas in a horse.
abstract: METHODS
  A 7-year-old 509-kg (1,120-lb) Tennessee Walking Horse mare was evaluated because of bilateral mucosanguinous nasal discharge, intermittent right-sided epistaxis, and worsening dyspnea of 9 months' duration.
  
  
  RESULTS
  Multiple masses in the nasopharynx were detected via endoscopic and radiographic examinations. Cytologic and histologic examinations of biopsy specimens of 1 mass revealed round yeasts with thick nonstaining capsules and occasional narrow-based budding that resembled cryptococcal organisms.
  
  
  RESULTS
  Oral administration of fluconazole and organic ethylenediamine dihydriodide and intermittent intralesional injections with fluconazole, amphotericin B, and formalin resulted in resolution of lesions for a period of 2.5 years. The horse then developed exophthalmos, recurring clinical signs, and extensive nasopharyngeal masses. The masses were surgically debulked via a large frontonasal bone flap, and the horse was treated with IV injections of amphotericin B and long-term oral administration of fluconazole. Clinical signs did not recur in the following 2-year period. A presumptive diagnosis of cryptococcosis was made following cytologic and histologic evaluations of the masses; results of serologic analysis and fungal culture confirmed infection with Cryptococcus neoformans.
  
  
  CONCLUSIONS
  Cryptococcal infection of the upper respiratory tract in horses has previously been described as a uniformly fatal disease. As this case report illustrates, medical and surgical treatment of sinonasal cryptococcal granulomas in horses may be successful, but the importance of long-term follow-up and the potential for disease recrudescence should be considered. As efficacious antifungal agents become less expensive, their increased use will likely decrease mortality rates in horses with fungal infections.
authors.affiliation: Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL 36849, USA.
authors.forename: Allison J
authors.initials: AJ
authors.lastname: Stewart
authors.forename: Tricia
authors.initials: T
authors.lastname: Salazar
authors.forename: Bryan M
authors.initials: BM
authors.lastname: Waldridge
authors.forename: John
authors.initials: J
authors.lastname: Schumacher
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: Welles
authors.forename: R Reid
authors.initials: RR
authors.lastname: Hanson
authors.forename: Eva A
authors.initials: EA
authors.lastname: Sartin
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Lenz
authors.forename: Merrilee
authors.initials: M
authors.lastname: Holland
authors.forename: Debra M
authors.initials: DM
authors.lastname: Beard
mesh_terms: D000818:Animals; D000935:Antifungal Agents / Q000627:therapeutic use; D003453:Cryptococcosis / Q000188:drug therapy / Q000601:surgery / Q000662:veterinary*; D005260:Female; D006099:Granuloma / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery / Q000662:veterinary*; D006734:Horse Diseases / Q000628:therapy*; D006736:Horses; D009668:Nose Diseases / Q000188:drug therapy / Q000601:surgery / Q000662:veterinary*
chemical_list: D000935:Antifungal Agents