Proliferative and necrotising otitis externa in a cat without pinnal involvement: video-otoscopic features

Case summaryA 14-year-old female spayed cat was referred for recurrent otitis externa and unusual proliferative lesions in both ear canals. The affected pinnae and external ear canals were covered with large reddish-to-dark-brown verrucous and necrotic tissue. Friable material and exudates occluded both ear canals. Proliferative lesions developed in both ears 2–3 weeks before referral. The histopathological diagnosis from two biopsies obtained from the friable materials with endoscopic biopsy forceps was proliferative and necrotising otitis externa (PNOE). Treatment was initiated with once-daily application of a potent topical glucocorticoid (mometasone furoate) to both ears. Although the auricle and vertical ear canals responded well, no improvement was seen in the horizontal part of the ear canal after 9 weeks. Therefore, oral triamcinolone (0.9 mg/kg q24h) was added for 1 week, and was then tapered (q48h) for 3 weeks. Most lesions resolved, and after a further 2 weeks of prednisolone (2 mg/kg q48h) there was complete resolution. No recurrence was observed during a 2 year follow-up period.Relevance and novel informationPNOE commonly occurs in kittens, but it can develop in older cats. To our knowledge, the PNOE in this case is the oldest age of onset reported. This condition is rare and was only described recently, and therapeutic options appear limited. According to previously published reports, steroid therapy is ineffective, and tacrolimus is the only treatment known to achieve resolution. However, oral and topical glucocorticoids were beneficial in this case.

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“…1–4 In contrast, glucocorticoid therapy has been reported to be only partially effective, at best. 2 …”

Section: Introductionmentioning

confidence: 99%

Contribution of oral triamcinolone to treating proliferative and necrotising otitis externa in a 14-year-old Persian cat

Momota

Yasuda

Arai

et al. 2017

Journal of Feline Medicine and Surgery Open Reports

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“…Otoscopic evaluation of the external ear canal and tympanic membrane should always be performed in animals presenting with otitis externa. 16 Thus, the presence of a foreign body, aural polyp and tumor in the ear canal were ruled out by otoscopy.…”

Section: Discussionmentioning

confidence: 99%

An unusual case of feline otitis externa due to sporotrichosis

Mascarenhas¹,

Botelho

Manier

et al. 2019

Journal of Feline Medicine and Surgery Open Reports

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Case summary It is described a case of a 10-month-old female mixed-breed cat with left ear discharge of approximately 6 days’ duration prior to the admission. Secretions were collected from both ears using a sterile swab for cytological and mycological analysis. A pyogranulomatous inflammatory infiltrate (predominantly characterized by the presence of neutrophils and macrophages) with the presence of cocci, rods and many yeast-like structures were seen on cytological analysis; the fungal culture confirmed the presence of the Sporothrix schenckii complex. Upon diagnosis of fungal otitis due to the S schenckii complex, treatment with oral itraconazole was administered. After 4 weeks of treatment, no S schenckii complex colonies were isolated, and clinical recovery had occurred. Relevance and novel information Although rare, clinicians must be aware of atypical presentations of sporotrichosis, as in this case of external otitis. This is of clinical relevance because this infection has been reported in several countries and is defined as a zoonotic disease.

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“…Although a few reports about PNOE have been published [1, 4, 9], the reported therapeutic options seem to be limited. Tacrolimus (FK506), is an immunosuppressive agent with a similar mechanism of action to cyclosporine, the most commonly used for PNOE [1, 4, 9]. On the other hand, glucocorticoid therapy has been reported to be ineffective or only partially effective [4].…”

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confidence: 99%

“…PNOE is a rare disease that has only been mentioned in four reports [1, 2, 4, 9]. The pathogenesis of PNOE is currently being explored.…”

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confidence: 99%

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Proliferative and necrotizing otitis externa in a kitten: successful treatment with intralesional and topical corticosteroid therapy

Momota

Yasuda

Ikezawa

et al. 2016

The Journal of Veterinary Medical Science

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Proliferative and necrotising otitis externa (PNOE) is a very rare disease affecting the ear canals and concave pinnae of kittens. This report describes a 5-month-old cat with PNOE. Histopathological examination confirmed the diagnosis. Treatment was initiated with local injection of methylprednisolone acetate into the lesions. The cat was subsequently treated with clobetasol propionate cream, a potent topical glucocorticoid ointment. The cat showed marked improvement. While topical treatment with tacrolimus, an immunosuppressive agent, is reported to be an effective therapy, to the best of our knowledge, this is the first report to treat PNOE with local corticosteroid therapy.

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Proliferative and necrotising otitis externa in a cat without pinnal involvement: video-otoscopic features

Cited by 15 publications

References 7 publications

Contribution of oral triamcinolone to treating proliferative and necrotising otitis externa in a 14-year-old Persian cat

Contribution of oral triamcinolone to treating proliferative and necrotising otitis externa in a 14-year-old Persian cat

An unusual case of feline otitis externa due to sporotrichosis

Proliferative and necrotizing otitis externa in a kitten: successful treatment with intralesional and topical corticosteroid therapy

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