Dr. Paul Hodges
Minimally Invasive Procedures
"Sniffles" the dog
"Sniffles", a 8 year old, male neutered mixed breed dog, presented to his regular veterinarian because of a history of sneezing and bleeding from one nostril (epistaxis).
At presentation "Sniffles" was eating and drinking normally, had good energy and seemed otherwise fine
General physical exam was normal except for signs of mild inflammation at the nostril on the affected side. Comprehensive bloodwork was all within normal limits.
Initial therapy with antibiotics was only mildly helpful but the sneezing and epistaxis continued past the course of medication.
Along with epistaxis, "Sniffles" started having a mucoid like nasal discharge bilaterally and his regular veterinarian recommended rhinoscopy (scoping of the nose) to try to identify the problem.
Rhinoscopy was performed in 2 steps beginning with a full examination of the back of the mouth and caudal nasopharynx using a flexible endoscope. During this examination there was some lobulated thickening along the dorsal aspect of the nasopharynx (lighter coloured on image above right) as well as appreciable soft tissue thickening on the left side (side with epistaxis). Biopsy samples were collected during this part of the examination.
The second part of the exam involved passing a 2.7mm 30 degree rigid endoscope with operating sheath through the nostrils to examine the anterior nasal passages. During this exam it was noted that both left and right nasal turbinates were very inflamed with areas of turbinate clubbing and polypoid growths. There were no foreign bodies or areas of single masses, but the nasal passages were diffusely affected (images to right and below). Biopsy samples were collected from both left and right nostrils.
"Sniffles" recovered from general anesthetic without any difficulties and the biopsy samples were sent to the lab for histopathology.
The biopsy results came back as nasal Blastomycosis. Unfortunately, "Sniffles" had continued to decline during this time and the owners elected humane euthanasia due to his quality of life.
Blastomycosis is a fungal (yeast) infection that is primarily found in soil and moist areas. It is relatively common in Southern Ontario (especially areas of "cottage country" such as the Muskokas, Georgian Bay, Bracebridge, Haliburton, etc.) and infection is usually through inhalation of spores or contamination of open sounds in skin. It is believed that the spores initally replicate in the lungs or wound site, but can then spread to other organs. This particular case is interesting in that Blastomycosis isolated to the nasal passages without other clinical signs is relatively rare. More common clinical signs of infection can be fever, cough, dyspnea (trouble breathing), or joint disease. Blastomycosis can spread to lymph nodes, the eyes, and other organs, but the most common presentation is respiratory problems. Chest x-rays will often show very typical changes suggestive of Blastomycosis and can help guide a diagnosis. Cytology and/or histopathology of affected tissue or secretions can also be helpful in identifying fungal spores. There is also a urine test that can be used to screen for disease. Blastomycosis is treatable but can often require long courses of antifungal medications and relapse is a possibility. Unfortunately, Blastomycosis can progress quickly and in some cases can be life threatening if not caught early enough in the disease process.