Localized intestinal cryptococcosis and co-parasitism in a juvenile dog

Abstract

An 8.5-month-old, male, entire golden retriever presented for 6-month history of large bowel diarrhoea and vomiting. Giardiasis was previously treated. Clinical signs recurred despite empirical antibiotics, food trials, probiotics and psyllium. Physical exam revealed circumferential cobblestone-like rectal mucosa. Rectal scrape cytology was consistent with cryptococcosis. Latex cryptococcal agglutination test was consistently negative. Thoracic radiographs were normal. Notable abdominal ultrasound findings included jejunal and suspected mesenteric cystic lymphadenopathy and multifocal areas of submucosal thickening. Abdominal lymph node aspirates revealed lymphoid hyperplasia. Faecal sedimentation and floatation revealed few Alaria species eggs and many Coccidia oocysts, respectively. Patient was treated with fluconazole, sulfadimethoxine, Drontal Plus and subsequently developed pancytopenia secondary to sulphonamide therapy requiring hospitalization, and recovered with supportive care and discontinuation of drug. Patient's clinical signs, rectal palpation and sonographic features resolved with continued fluconazole therapy. This case demonstrates localized intestinal cryptococcosis based on cytology with negative latex cryptococcal agglutination test and pancytopenia secondary to sulphonamide therapy for co-parasitism.