6/6/2024

DVM Intake Exam Estimated age: 6-8 years based on condition of teeth/eyes Microchip noted on Intake? Scanned negative History: Stray Subjective: BAR Observed Behavior - aloof, allows all handling, eating during exam Is there evidence of Cruelty? No Is there evidence of Neglect? No Is there evidence of Trauma? No Objective T = P = WNL R = WNL BCS: 3/9 EENT: Eyes clean, ears clean, unilateral bloody nasal discharge from left nares when wiped away pink fleshy mass noted at opening. No ocular discharge noted Oral Exam: Adult dentition, mild staining, no apparent tartar PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupneic ABD: Non painful, no masses palpated U/G: Externally WNL, suspect intact female, no OHE scar or tattoo noted MSI: Ambulatory x 4, skin free of parasites, no masses noted, round wound/flat mass on right side of nasal bridge with dried bloody discharge, dull hair coat CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: Externally WNL Wood's Lamp Exam: negative Assessment wound on right side of nasal bridge Mass on left side of nares (see vet docs)- r/o benign adenoma vs. squamous cell carcinoma vs. other Intact female Underweight Prognosis: Poor to fair Plan: Intake tasks/exam CBC/CHM/TT4 Await sort Wound benefit from rescue placement for further mass work up +/- removal SURGERY: Temporary waiver due to being underweight

6/6/2024

Fine needle aspirate of nasal mass, appears to be consistent with cryptococcus neoformanns (fungal). Photos in vet docs. P: Rx: Itraconazole 10mg/ml 2.7 ml PO SID x 3 months

6/6/2024

CBC HCT 37.9% Hgb 12.7 g/dL WBC 6 k/uL - mild lymphopenia 0.7 K/uL - mild eosinopenia 0.01 K/uL CHM Glucose 126 mg/dL SDMA 11 ug/dL Creatinine 2.2 mg/dL BUN 41 mg/dL (16-36) Total protein: 9.2 g/dL (5.7-8.9) Hyperglobulinemia 5.7 g/dL ALT/ALP WNL Hypernatremia 174 mmol/L (150-165) Other electrolytes WNL TT4 2.0 ug/dL A: Decreased lymphocytes and eosinophils- r/o stress vs. systemic infection vs. other Elevated BUN- r/o hydration status vs. other Elevated proteins characterized by hyperglobulins- r/o inflammation vs. other Hypernatremia- r/o hydration status vs. other P: CWCT

6/8/2024

SO: Nasal and skin mass near medial canthus. Aspirate of nasal mass c/w fungal disease, likely cryptococcus. Currently on itraconazole BAR, tense at back of kennel initially, but warms up. Ate all wet food in kennel overnight eent: eyes clear, no ocular dc apparent, mild crusting dc and visible mass at L nares, other skin mass near R medial canthus h/l: eupneic, no coughing or sneezing appreciated msi: ambulatory x4 neuro: mentation alert and appropriate A: suspected cryptococcus P: continue current treatment plan

6/9/2024

Pet did not eat o/n. A: Hypo/anorexia r/o side effect of itraconazole vs other Plan LRS 100 ml SQ x 3 days Cerenia 10mg/ml 0.3 ml SQ sid x 3d

6/11/2024

Pet ate all of food o/n. QAR in cage.

6/14/2024

Hx: mass on nares appears to be consistent with Cryptococcus, wound near right medial canthus/nasal bridge S: QAR, ate o/n O: EEN- eyes clear, no nasal or ocular discharge H/L- normal sinus rhythm, no murmur noted, lungs clear, eupneic, no coughing/sneezing or audible congestion noted MSK/I- Ambulatory x4, dull hair coat Neuro- alert/appropriate A: Cryptococcus Eating P: CWCT

6/22/2024

Hx: mass on nares c/w cryptococcus, wound to right side of medial canthus S: BAR, purring + rubbing on kennel bars, food eaten o/n O: EEN- eyes clear, mild audible congestion but obstructed left nares H/L- Eupneic MSK- Ambulatory x4 Neuro- alert/appropriate A: Reweigh, gaining weight Eating Cryptococcus Wound to right side of eye P: CWCT