Presumptive Nocardia spp. infection in a dog treated with cyclosporin and ketoconazole

Abstract

CASE HISTORY: A dog that had received 8 months of cyclosporin and ketoconazole therapy for treatment of atopic dermatitis subsequently developed severe neurological disease, that failed to respond to treatment with trimethoprim-sulphadiazine and clindamycin.

HISTOPATHOLOGICAL FINDINGS: Histopathological examination of the pulmonary parenchyma and spinal cord revealed loose aggregates of Gram-positive, partially acid-fast, fine, beaded, filamentous bacteria, most consistent with Nocardia spp.

DIAGNOSIS: A presumptive diagnosis was made of disseminated nocardiosis of the spinal cord and lungs.

CLINICAL RELEVANCE: Nocardia spp. is an opportunistic actinomycete that may cause disseminated disease, particularly in immunocompromised animals. Cyclosporin is used in veterinary medicine to control immune-mediated and allergic disorders, with few reported adverse side effects. This case gives further evidence that involvement of the spinal cord in nocardiosis of the central nervous system (CNS) carries a poor prognosis, and opportunistic infection by Nocardia spp. may be a potential complication of immunosuppressive cyclosporin therapy in the dog.

KEY WORDS:

• Nocardia spp.
• cyclosporin
• spinal cord
• dog

Acknowledgements

The authors thank Dr Anika Oksa in the Anatomical Pathology Department for interpretation of histopathology specimens, Radiology Department for interpretation of computed tomographic images, and Clinical Pathology Department for photography of slide preparations, of Murdoch University.