Sometimes it is just 2 diagnosis....

Computed Tomographic and Magnetic Resonance Imaging Diagnosis of Concurrent Sinonasal Aspergillosis and Meningoencephalocele in a Dog

Grant Ford-Hodges, Silke Hecht, Jacqueline C. Whittemore

Background
Sinonasal aspergillosis is a common fungal infection in dogs, typically affecting medium to large breeds and associated with chronic nasal discharge. Meningoencephaloceles—herniation of cerebral tissue through skull defects—are rare congenital anomalies in dogs. Concurrent presentation of these conditions is exceedingly rare, with only one previous case reported. This case report details the diagnosis and management of a dog with both sinonasal aspergillosis and a meningoencephalocele, emphasizing the diagnostic and therapeutic approach and long-term outcome.

Methods
A 4-year-old male mixed-breed dog with a history of seizures and recent progressive unilateral nasal discharge underwent computed tomography (CT) and magnetic resonance imaging (MRI) for diagnostic evaluation. CT revealed a large left-sided cribriform plate defect with olfactory bulb herniation into the nasal cavity and concurrent destructive rhinitis consistent with aspergillosis. Rhinoscopy with biopsy, debridement, and clotrimazole cream infusion was performed. Histopathology and fungal culture confirmed Aspergillus fumigatus. Follow-up included clinical exams, repeat rhinoscopy, and a second treatment for recurrence. The patient was monitored for seizure control and nasal disease recurrence over a 3-year period.

Results
Imaging confirmed a large left-sided meningoencephalocele and sinonasal aspergillosis. Rhinoscopy revealed fungal plaques adherent to the herniated olfactory bulb. Debridement and topical antifungal therapy with clotrimazole cream were well tolerated. Clinical signs resolved following initial treatment, with recurrence at 4 months successfully managed with repeat therapy. No signs of disease were noted at 1-month recheck, and the dog remained symptom-free for 3 years, until seizure recurrence prompted phenobarbital dose adjustment. No complications arose from topical treatment despite the cribriform defect and direct fungal plaque contact with neural tissue.

Limitations
As a single case report, the findings are not generalizable. Histologic evaluation of the herniated neural tissue post-treatment was not feasible, and the exact cause of seizure recurrence after 3 years could not be definitively determined. The impact of topical antifungal exposure to brain tissue remains speculative.

Conclusions
This case demonstrates that sinonasal aspergillosis involving herniated brain tissue in dogs with meningoencephaloceles can be effectively managed with standard topical antifungal therapy and careful monitoring. Aggressive debridement and repeat rhinoscopy are critical to treatment success. Despite traditional contraindications, this case supports the cautious use of topical treatment even with cribriform plate defects, provided neurologic oversight is included.

Disclaimer: The summary generated in this email was created by an AI large language model. Therefore errors may occur. Reading the article is the best way to understand the scholarly work. The figure presented here remains the property of the publisher or author and subject to the applicable copyright agreement. It is reproduced here as an educational work. If you have any questions or concerns about the work presented here, reply to this email.