PMC8757464_01
Four right lateral thoracic radiographs obtained from a cat with a compressive Coccidioides spp. spinal granuloma from initial presentation and three time points after decompressive neurosurgery and fluconazole therapy. (A) Earliest study performed on initial presentation, before surgery, revealed a miliary pulmonary pattern with numerous small soft tissue nodules (white chevrons) in all lung lobes and sternal lymphadenomegaly (solid white arrow); (B) On day 35 there were fewer pulmonary nodules (white chevrons) and the sternal lymphadenomegaly remained static (solid white arrow); (C) Three months later (day 140), there were even fewer pulmonary nodules (white chevrons) and the sternal lymphadenomegaly remained relatively static (solid white arrow); (D) Six months following images in C (day 310), there was resolution of the pulmonary nodules and the sternal lymphadenomegaly was static (solid white arrow).
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F1
Three-view spinal and thoracic radiographs were procured and showed a diffuse miliary pattern (structured interstitial pattern) consisting of numerous small, ill-defined soft tissue nodules (~3 mm) within all lung lobes (Figure 1A). A right hemilaminectomy/spinal exploratory surgery at mid-body of L4 was performed (Supplemental Figure 1). No extradural lesion was present upon opening the window, but the spinal cord was focally swollen and discolored over the midbody of L4 (Supplemental Figure 1A). A durectomy was performed over the exposed spinal cord and revealed a swollen and discolored spinal cord segment (Supplemental Figure 1B). A myelotomy was performed that revealed an intra-medullary mass (Supplemental Figure 1C). The mass was approximately 0.75 cm, round, semi-firm, and was removed en bloc (Supplemental Figure 1D). The spinal cord ventral to the mass was bruised and substantially compressed, leaving an indent that gradually re-expanded as the mass was removed (Supplemental Figure 1D). The overall dark purple coloring of the spinal cord gradually improved (Supplemental Figure 1E). Thoracic radiographs revealed an improvement to the miliary pulmonary pattern with static sternal lymphadenomegaly (Figure 1B). The sternal lymphadenomegaly was still identifiable and similar to the previous study (Figure 1C). Thoracic radiographs at this time showed resolution of the pulmonary nodules (Figure 1D).
Computed tomography of the thorax in a cat with a compressive Coccidioides spp. spinal granuloma before surgery or administration of fluconazole. (A) Sagittal plane reconstruction with soft tissue window display. The sternal lymph node was enlarged (sold white arrow) with a peripheral contrast enhancement. There was also enlargement of the tracheobronchial lymph node (hollow white arrow); (B) Transverse plane reconstruction with bone window display, and (C) Dorsal plane reconstruction with bone window display. There were numerous, irregular, small soft tissue nodules (white chevrons) within all lung lobes.
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F2
The diffuse miliary pulmonary pattern was confirmed with the CT scan (Figures 2B,C). There was also mild enlargement of the tracheobronchial lymph nodes, cranial mediastinal lymph nodes, and sternal lymph node (Figure 2A).
Computed tomography of the lumbar spine in a cat with a compressive Coccidioides spp. spinal granuloma before surgery or administration of fluconazole. (A) Transverse plane reconstruction, pre-contrast series with soft tissue display. There was enlargement of the spinal cord silhouette (black arrow) that attenuated the epidural fat circumferentially; (B) Transverse plane reconstruction, post-contrast series with soft tissue display, and (C) Dorsal plane reconstruction, post-contrast series. There was diffuse, strong contrast enhancement of the enlargement of the spinal cord silhouette (black arrow).
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F3
In the pre-contrast series, there was an isoattenuating widening of the spinal cord silhouette dorsal to the vertebral body of L4 (Figure 3A). There was an expansile widening of the spinal canal dorsal to L4 associated with the strongly contrast-enhancing mass (Figures 3B,C).
Representative cytological images of sternal lymph node (A,B) and histopathological images of spinal cord granuloma (C,D) in a cat with spinal coccidioidomycosis. (A) Multiple immature Coccidioides spp. spherules (arrows) with surrounding pyogranulomatous inflammation. Wright-Giemsa, 50x objective, Scale bar = 20 mum; (B) Several free Coccidioides spp. endospores (arrowheads). Wright-Giemsa, 100x objective, Scale bar = 10 mum; (C) Neuroparenchyma obscured by mixed inflammation predominated by neutrophils and macrophages admixed with numerous Coccidioides spp. spherules (arrow). Hematoxylin and eosin (H and E). Scale bar = 50 mum; (D) Occasional Coccidioides spp. spherules are filled with endospores (arrow) (H and E). Scale bar = 20 mum.
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F4
Coccidioides spp. spherules and endospores (Figures 4A,B). Cisternal cerebral spinal fluid (CSF) was examined cytologically and revealed a nucleated cell count of 1 cell/muL (normal, <8 cells/muL), a red blood cell count of 2,470 cells/muL (reference, 0 cells/muL), and a total protein of 22.5 mg/dL (reference, <25 mg/dL). At the periphery of sections, residual neuroparenchyma contained gemistocytic astrocytes, acute hemorrhage, degeneration, and malacia (Figures 4C,D).