A 3½-week-old Holstein heifer calf was presented to Cornell University Hospital for Animals (CUHA) with a 2-week history of intermittent fever, coughing, and decreased growth and a 1-week history of drooling and droopy ears. The calf had been treated with several antibiotics without marked improvement. On physical examination, the calf was depressed, underweight, bradycardic (heart rate 60 bpm) and febrile (103.4ЊF, 39.7ЊC). Clinical signs attributable to cranioventral pneumonia included bilateral mucopurulent nasal discharge, coughing, and abnormal bronchial tones. Intermittently, there were food particles in the nasal discharge, ptyalism, difficult prehension and mastication of food, and regurgitation of green material from both the nose and mouth. Neurologic examination revealed depression, bilateral facial nerve paresis (decreased lip, eyelid, and ear tone; absent palpebral or menace reflex), and bilateral vestibular disease (balance loss to either side, no head tilt, and loss of physiologic vestibular nystagmus). No abnormal nystagmus was observed, but the eyeballs did not show the physiologic vestibular eyedrop on head and neck extension. The gait was normal. The diagnosis of bilateral cranial nerve (CN) VII and VIII disease suggested bilateral otitis media/interna. Deep palpation of the base of the ears elicited a pain response and nonodorous otorrhea was present, indicating a component of otitis externa. Upper airway and esophageal endoscopy was consistent with dysphagia and disturbed esophageal motility and showed tracheal mucopus, nasopharyngeal collapse, dorsal displacement of the soft palate, and esophageal dilatation with few contractions. Thoracic radiography and transtracheal aspirate cytology (many degenerate neutrophils, few macrophages, large amounts of mucus, no bacteria) confirmed the presence of bronchopneumonia. The transtracheal aspirate yielded Arcanobacter pyogenes and Mycoplasma spp., but fluorescent antibody testing for common respiratory viruses was negative. CBC results were normal. Lumbosacral cerebrospinal fluid (CSF) had a slightly high nucleated cell count (9 nucleated cells/L, normal Ͻ5 cells/L; total protein concentration 17 mg/dL, normal Ͻ70 mg/dL). Lateral skull radiographs did not show abnormalities, but computed tomography (CT) imaging indicated that both tympanic bullae and the right petrous temporal bone were enlarged,
