Case Report: Successful Management of a Compressive Intraspinal Coccidioides Species Granuloma in a Cat

A 9-year-old, neutered male, domestic shorthair cat from Arizona, was presented for evaluation of a 7-day history of hind limb paraparesis that progressed to paraplegia. There was no history of respiratory abnormalities. Neurologic examination supported localization of a T3-L3 myelopathy. Computed tomography (CT) revealed an expansile widening of the spinal canal dorsal to L4 associated with a strongly contrast-enhancing mass. Moreover, CT series of the thorax revealed a diffuse miliary pulmonary pattern, as well as tracheobronchial, sternal, and cranial mediastinal lymphadenomegaly. Transthoracic lung lobe and sternal lymph node fine needle aspiration revealed pyogranulomatous inflammation with Coccidioides spp. spherules and endospores. A suspected diagnosis of spinal coccidioidomycosis was made; fluconazole (10.9 mg/kg PO q12h) treatment was initiated, and decompressive neurosurgery was performed. The granuloma was removed en bloc and histopathology revealed marked, chronic-active, pyogranulomatous myelitis with intralesional Coccidioides spp. spherules with endosporulation. Serum anti-Coccidioides spp. antibody titer results revealed a negative IgM and a positive IgG (1:4). The cat was treated with fluconazole for 445 days and examined at various time points, with the last examination 2 years after initial presentation. The cat returned to full ambulation with only mild functional deficits of the right hind limb. In conclusion, this report documents the diagnosis, treatment, and long-term follow up of a cat with a compressive Coccidioides spp. spinal cord granuloma. This case highlights the importance of including coccidioidomycosis as a differential diagnosis for cats with peracute hindlimb paraplegia that have lived in or traveled to regions where Coccidioides spp. is endemic, and demonstrates the potential for a good long-term outcome with decompressive neurosurgery and antifungal therapy.

Underlying causes of persistent pneumonia in children at the Intensive Care Unit,Vietnam National Children’s Hospital

The study describes underlying causes of children with severe persistent pneumonia (sPP) admitted to the Intensive Care Unit (ICU), Vietnam National Children’s Hospital. In the prospective and descriptive study, all patients classified as sPP (pneumonia persisting for 30 days or more, despite receiving antibiotics for a minimum period of 10 days), admitted to ICU, Vietnam National Children’s Hospital from November 2019 to August 2020 were recruited. Patients were divided into groups based on having a recurrent lesion in the same lobe or lesion in multiple lobes before undergoing several investigational tests to identify the underlying causes. 82 patients with sPP accounted for 21.9% of children admitted to ICU due to pneumonia and 10.6% of total patients at ICU. Underlying causes were diagnosed in 82.9% of sPP children, with the most common causes are abnormalities in respiratory (19.5%), immune disorders (18.3%), congenital heart diseases (17.1%). Underlying causes couldn’t be identified in 17.1% of the patients, among whom necrotizing pneumonia or lung abscess account for 50%, ARDS 21.4%, and tuberculosis 14.3%. Local and recurrent x-ray lesions in one lung lobe accounted for 22%.

Late Lung Metastasis in a Patient with a Clear Cell Chondrosarcoma: An Indication for a Life-Long Follow-Up?

Background. Clear cell chondrosarcoma (CCCS) is a rare subtype of chondrosarcoma and comprises between 1.6% and 2.5% of all chondrosarcoma. They are known to be chemo- and radiotherapy resistant; surgical resection is therefore the therapy of choice. Methods. We present a 63-year-old woman with a progressive lung nodule 20 years after initial diagnosis and treatment of a clear cell chondrosarcoma of the right os naviculare. Results. On serial CT scans of the chest, an asymptomatic, slowly growing nodule in the left upper lung lobe was detected. CT-guided transthoracic biopsy of this nodule confirmed the diagnosis of a chondrosarcoma lung metastasis. Video-assisted thoracoscopic wedge resection was performed with complete removal of the nodule. The patient recovered well from surgery and remains in good health during further follow-up. Conclusion. Given the tendency of clear cell chondrosarcoma to recur and metastasize after extended periods of time, a long-term, possibly life-long follow-up and clinical surveillance is advisable in these patients.

Pulmonary fungal ball due to Trichophyton successfully managed with oral itraconazole: a case report

Pulmonary fungal balls are caused by long-term fungal infection of the lung. They are sometimes a complication of previous cavitary pulmonary tuberculosis. Pulmonary fungal balls caused by Trichophyton are extremely rare. A 65-year-old man who worked in a leather recycling factory was admitted because of a productive cough and shortness of breath. He had a history of tuberculosis with lung destruction. A chest radiograph showed an opacity surrounding an air lucency over the left lung field, and chest computed tomography showed a mass within a cavity, producing a ball-in-hole appearance, over the left upper lung lobe. Bronchoalveolar lavage was performed, and fungal culture of the lavage fluid yielded Trichophyton. After 6 months of treatment with oral itraconazole, the patient’s general condition improved. This case emphasizes the importance of awareness of fungal infection within cavitary lesions of the lung and shows that Trichophyton may be the etiologic organism in such cases. Itraconazole is a recommended treatment of pulmonary fungal balls.

Disseminated Fungal Infection and Fungemia Caused by Trichosporon asahii in a Captive Plumed Basilisk (Basiliscus plumifrons)

Trichosporon spp. are heavily arthroconidiating fungi and widely distributed in nature. Due to the similar fungal morphology, confusion among Trichosporon spp., Geotrichum spp., and Nannizziopsis spp. in reptiles is apparent and cannot be overlooked. Although few reptile Trichosporon isolates have been examined using the newer speciation criteria, the information on Trichosporon asahii in reptiles is still scarce. In the present study, we report the case of disseminated fungal infection and fungemia caused by T. asahii in a captive plumed basilisk (Basiliscus plumifrons). Multiple 0.2–0.5 cm, irregularly shaped, ulcerative nodules on the left hind foot were observed. The animal died due to the non-responsiveness to treatment. A microscopic evaluation revealed the fungal infection that primarily affected the left hind foot and right lung lobe with fungal embolisms in the lung and liver. The molecular identification of the fungal species by the DNA sequences of the ITS regions and D1/D2 gene from the fungal culture and ITS regions, from formalin-fixed paraffin-embedded (FFPE) lung tissues, were completely matched to those of T. asahii. The current report describes the first confirmed case of disseminated fungal infection and fungemia caused by T. asahii in a captive plumed basilisk.

Water Cycle Bat Algorithm and Dictionary-Based Deformable Model for Lung Tumor Segmentation

Among the different types of cancers, lung cancer is one of the widespread diseases which causes the highest number of deaths every year. The early detection of lung cancer is very essential for increasing the survival rate in patients. Although computed tomography (CT) is the preferred choice for lungs imaging, sometimes CT images may produce less tumor visibility regions and unconstructive rates in tumor portions. Hence, the development of an efficient segmentation technique is necessary. In this paper, water cycle bat algorithm- (WCBA-) based deformable model approach is proposed for lung tumor segmentation. In the preprocessing stage, a median filter is used to remove the noise from the input image and to segment the lung lobe regions, and Bayesian fuzzy clustering is applied. In the proposed method, deformable model is modified by the dictionary-based algorithm to segment the lung tumor accurately. In the dictionary-based algorithm, the update equation is modified by the proposed WCBA and is designed by integrating water cycle algorithm (WCA) and bat algorithm (BA).

Clinical characteristics and long-term outcome of lung lobe torsions in cats: a review of 10 cases (2000–2021)

Case series summary Lung lobe torsion is rare in cats. The aim of this multi-institution retrospective study was to describe clinical and diagnostic findings, treatments and outcomes of lung lobe torsion (LLT) in 10 cats. Dyspnoea and tachypnoea were the most common clinical signs. Pleural effusion was present in nine cats at presentation. Fluid analysis confirmed chylothorax in three cats. Nine cats underwent CT and five cats had thoracic radiographs taken. A diagnosis was made preoperatively in six cats, while in the other four cats it was made at exploratory thoracotomy. Affected lung lobes were the right cranial (n = 4/11), left cranial (n = 4/11) and right middle (n = 3/11). One cat had a concurrent torsion of two lung lobes. Lung lobectomy was successfully performed in all cases. Based on clinical, diagnostic and lung histopathology findings, three cats had idiopathic and seven cats secondary LLT. Intraoperative complications included hypotension and hypothermia in four and five cats, respectively. Postoperative complications occurred in six cats and lead to euthanasia or death in four cats, whereas complications resolved in the other two cats. Three cats were euthanased within 5 weeks of discharge. For the three cats surviving long term, including one euthanased at 252 days postoperatively, owner-described outcomes and quality of life were considered good to excellent. Relevance and novel information Secondary LLT associated with underlying thoracic pathology was associated with high complication rates and poor outcomes. Long-term outcomes of cats undergoing surgery for LLT and surviving the perioperative period were deemed good to excellent.

A Comparative Study of Chest CT With Lung Ultrasound After SARS-CoV-2 Infection in the Assessment of Pulmonary Lesions in Rhesus Monkeys (Macaca Mulatta)

Lung ultrasound (LUS) is a fast and non-invasive modality for the diagnosis of several diseases. In humans, LUS is nowadays of additional value for bedside screening of hospitalized SARS-CoV-2 infected patients. However, the diagnostic value of LUS in SARS-CoV-2 infected rhesus monkeys, with mild-to-moderate disease, is unknown. The aim of this observational study was to explore correlations of the LUS appearance of abnormalities with COVID-19-related lesions detected on computed tomography (CT). There were 28 adult female rhesus monkeys infected with SARS-CoV-2 included in this study. Chest CT and LUS were obtained pre-infection and 2-, 7-, and 14-days post infection. Twenty-five animals were sub-genomic PCR positive in their nose/throat swab for at least 1 day. CT images were scored based on the degree of involvement for lung lobe. LUS was scored based on the aeration and abnormalities for each part of the lungs, blinded to CT findings. Most common lesions observed on CT were ground glass opacities (GGOs) and crazy paving patterns. With LUS, confluent or multiple B-lines with or without pleural abnormalities were observed which is corresponding with GGOs on CT. The agreement between the two modalities was similar over the examination days. Pleural line abnormalities were clearly observed with LUS, but could be easily missed on CT. Nevertheless, due to the air interface LUS was not able to examine the complete volume of the lung. The sensitivity of LUS was high though the diagnostic efficacy for mild-to-moderate disease, as seen in macaques, was relatively low. This leaves CT the imaging modality of choice for diagnosis, monitoring, and longitudinal assessment of a SARS-CoV-2 infection in macaques.