title: Successful management of an intracranial phaeohyphomycotic fungal granuloma in a dog.
abstract: METHODS
  A 12-month-old castrated male Boxer was examined because of signs of acute, progressive intracranial disease.
  
  
  RESULTS
  Cytologic and histologic findings were consistent with an intracranial fungal granuloma in the right cerebral hemisphere. Fungal culture yielded a Cladophialophora sp.
  
  
  RESULTS
  The granuloma was surgically debulked to remove infected brain tissue and the avascular purulent core. Postoperatively, the patient was treated with fluconazole (2.3 mg/kg [1 mg/lb], PO, q 12 h) for 4 months, followed by voriconazole (3.4 mg/kg [1.5 mg/lb], PO, q 12 h) for a further 10 months. The outcome was considered excellent on the basis of resolution of neurologic signs and a lack of evidence of recurrence of the granuloma during magnetic resonance imaging and CSF analysis 8 months after surgery. Magnetic resonance imaging and CSF analysis 9 weeks after administration of antifungal medications was discontinued (16 months after surgery) confirmed resolution.
  
  
  CONCLUSIONS
  Intracranial phaeohyphomycosis in small animals is rare and is most commonly associated with Cladophialophora infection. Phaeohyphomycosis frequently causes a focal granuloma, whereas other fungal infections typically cause diffuse meningoencephalitis. In all previous reports of phaeohyphomycosis of the CNS in dogs, treatment has been limited to medical management with conventional antifungal drugs and had failed to prevent death. The present report suggested that combined management of granulomas with surgery and newer triazole medications such as voriconazole may represent a novel strategy that improves the prognosis for this disease.
authors.affiliation: Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA. rbentley@purdue.edu
authors.forename: R Timothy
authors.initials: RT
authors.lastname: Bentley
authors.forename: Dominik
authors.initials: D
authors.lastname: Faissler
authors.forename: James
authors.initials: J
authors.lastname: Sutherland-Smith
mesh_terms: D000818:Animals; D000935:Antifungal Agents / Q000627:therapeutic use*; D060425:Cerebral Phaeohyphomycosis / Q000473:pathology / Q000628:therapy / Q000662:veterinary*; D004283:Dog Diseases / Q000473:pathology / Q000628:therapy*; D004285:Dogs; D015725:Fluconazole / Q000627:therapeutic use*; D006099:Granuloma / Q000382:microbiology / Q000473:pathology / Q000628:therapy / Q000662:veterinary*; D008297:Male; D011743:Pyrimidines / Q000627:therapeutic use*; D014230:Triazoles / Q000627:therapeutic use*; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D015725:Fluconazole; D065819:Voriconazole