Feline cutaneous nodular and ocular Cryptococcus neoformans in Belgium

CASE SUMMARY: An 11-year-old spayed female cat presented with a 6-month history of a progressive nodular skin disease with concurrent, ocular lesions, intermittent vomiting, halitosis and weight loss. The cat had received different topical treatments without success prior to referral to the Dermatology Department of Faculty of Veterinary Medicine, Ghent University. Several fine-needle aspirations of the lesions showed a vast number of macrophages with intra-cytoplasmic inclusions compatible with Cryptococcus species. Histopathological examination revealed pyogranulomatous inflammation with capsulated yeast. Periodic acid–Schiff stain was positive. Latex cryptococcal antigen agglutination test on serum was positive with a titre of >1/524,288. PCR and fungal culture identified Cryptococcus neoformans. The cat was treated with itraconazole 10 mg/kg PO q24h. After 10 months of therapy, there was a complete resolution of the lesions except for a small nodule on the ventral aspect of the tongue. RELEVANCE AND NOVEL INFORMATION: As far as we are aware, this is the first feline case reported of cutaneous nodular cryptococcosis without nasal involvement in Belgium. Oral itraconazole therapy was well tolerated and appeared to give a good result and prognosis.