A 1.5-year-old spayed female Vizsla presented to the Cornell University Hospital for Animals (CUHA) Emergency Service for evaluation of a two-week history of inappetence, lethargy, coughing, and weight loss. Prior to arriving at the CUHA, she presented to her primary care veterinarian for 2 days of inappetence, strange breathing, and coughing. She was febrile, had mild conjunctivitis in both eyes, and was lethargic. Chest radiographs revealed a severe bronchial pattern and two large pulmonary nodules. The radiograaphs were repeated two more times over the next week, and the changes were increasing in severity. She was treated with amoxicillin, itraconazole, fenbendazole, and meloxicam. Her bloodwork at the time (CBC/Chemistry Panel) was unremarkable. Fungal serology was negative for Aspergillus, Blastomyces, Coccidioides, Histoplasma, and Cryptococcus. Three days later, she returned to her referring veterinarian for vomiting worms and continued inappetence. She received mirtazapine and repeat blood work revealed mild lymphocytosis, moderate neutrophilia, and increased hematocrit. The patient spends time outdoors in New York State and in Pennsylvania, swimming in the Susquehanna River. She has no other pertinent travel history.

On initial presentation to the CUHA, the patient’s only abnormal physical findings were mildly increased lung sounds diffusely throughout the lung fields. She was subsequently admitted for emergency room diagnostics and transferred to the Internal Medicine Service for further diagnostics and treatment. An extensive physical exam revealed harsh lung sounds across all lung fields, prominent mandibular lymph nodes, with the left lymph node being more prominent than the right, and a hacking cough elicited on palpation of her throat.

An abdominal ultrasound was unremarkable and urine was collected for urine Blastomyces antigen, which returned positive. After an episode of epistaxis and ruling out a coagulopathy, a computed tomography scan of the head and neck was performed. It showed a unilateral (left), destructive sinorhinopathy with mass effect and cranial cavity invasion, as well as a severe, diffuse, miliary lung pattern and multiple small random lung nodules. After discussing the top differential diagnoses with the owner, a bronchoscopic exam, bronchoscopic lavage, and rhinoscopy with biopsies were performed.

This report will discuss the case at hand, as well as the epidemiology, pathogenesis, diagnosis, and treatment of blastomycosis.