Keep mycotic disco on your ddx

Clinical Signs, Advanced Diagnostic Imaging Findings, Treatment, and Outcome of Mycotic Discospondylitis in 11 Dogs

Samuel Okonji 1,✉, Andrea Di Paola 2, Silvia Benini 1, Antonella Gallucci 3, Alberto Cauduro 2, Cristian Falzone 4, Teresa Gagliardo 5, Gualtiero Gandini 1

Background:
Mycotic discospondylitis (MD), an infection involving the intervertebral disc and adjacent vertebral endplates caused by fungal pathogens, is rare and often misdiagnosed in dogs. While bacterial discospondylitis is well-documented with favorable outcomes, literature on MD is limited and associated with poor prognosis. This study aimed to provide comprehensive clinical, imaging, treatment, and outcome data for 11 confirmed canine MD cases.

Methods:
This retrospective case series evaluated medical records from five veterinary neurology centers between 2017 and 2024. Inclusion required evidence of discospondylitis on advanced imaging (MRI or CT), cytological confirmation of fungal hyphae, and outcome data. Imaging findings were compared across modalities, and treatment regimens were analyzed for efficacy.

Results:
Eleven dogs met the inclusion criteria, with German Shepherds being overrepresented (7/11). All dogs exhibited spinal pain, and nine showed gait abnormalities. T3-L3 spinal cord localization was common. MRI consistently revealed more disc involvement than radiography. Aspergillus spp. was the predominant pathogen (7/11). Despite antifungal therapy, median survival was only 30 days, with just one dog alive at 1210 days post-diagnosis. MRI proved superior for early detection and identification of multiple lesions. Spinal epidural empyema was seen in nearly half the cases.

Limitations:
The study’s retrospective nature, small sample size, and variable diagnostic and treatment protocols limit generalizability. Lack of standardized treatment, selective spinal imaging, and absence of antifungal susceptibility testing (antimycogram) may have affected outcomes.

Conclusions:
MD in dogs presents with nonspecific signs similar to bacterial discospondylitis but carries a significantly worse prognosis. Diagnosis requires fungal confirmation due to overlapping imaging features. German Shepherds may be predisposed. Prompt diagnosis and aggressive treatment are essential, although prognosis remains guarded. MRI is recommended for accurate lesion identification, and fungal culture is crucial for targeted antifungal therapy.

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