We successfully treated a feline case of cryptococcosis with itraconazole (ITZ) at a lower dosage. The patient was a 2-year-old castrated male Abyssinian cat weighing 4.1 kg and with two masses on the head. Clinical signs were sneezing and nasal discharge. The plasma cryptococcal antigen titer measured by the latex agglutination test was proved to be high (512). The biopsy specimen from the masses disclosed yeast cells which were cultured and identified to be Cryptococcus neoformans. The cat was treated with ITZ 5 mg kg-1 given orally once a day with food. After 4 weeks, treatment of ITZ discontinued, because the cat was clinically normal and the antigen titer was low (128). However, about 7 months later, a subcutaneous nodule was detected on the same area. The nasal discharge appeared again, and the cryptococcal antigen titer was 256. ITZ treatment was continued again at the same dosage for 3 months until the antigen titer was negative (< 8). Four months after discontinuation of ITZ, the cat did not relapse and the antigen titer was in the negative range. No side-effects of ITZ were detected by physical and laboratory examination.
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Itraconazole was used in 35 cats with cryptococcosis. Treatment response was determined by comparing clinical signs before, during, and after treatment. It could not be evaluated in 7 cats because they died during treatment from causes unrelated to cryptococcosis. Of the remaining 28 cats, treatment response was classified as success in 16 cats (57%), as improvement in 8 cats (29%), and as a failure in 4 (14%). The failures were due to death or euthanasia from drug toxicity (1 cat), progressive fungal disease (2 cats), and relapse 1 year after treatment (1 cat). The cats that improved did not undergo a 1-year posttreatment evaluation because they were lost to follow-up (3 cats), died or were euthanatized for other reasons (4 cats), or had a noncompliant owner (1 cat). For the 16 cats in which treatment was successful, the median itraconazole dose was 13.8 mg/kg body weight daily (range, 10.9 to 26.7 mg/kg/d), and the median duration of treatment was 8.5 months (range, 4 to 16 months). Five of these cats had previously been treated unsuccessfully with ketoconazole.
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