Notoedres cati-induced bilateral erythemato-ceruminous otitis externa in a cat

Notoedric mange, caused by Notoedres cati (N. cati), is a rare but severe parasitic skin disease primarily affecting stray cats, with zoonotic potential. This case report describes a one-year-old intact male European Shorthair presented with extensive cervico-facial skin lesions and systemic illness signs. Clinical examination revealed severe pruritus, alopecia, thick crusts, bilateral erythemato-ceruminous otitis externa and deep pyoderma, with the maximum severity score on the clinical mange scale. Complementary tests confirmed N. cati infestation through skin scrapings and ear wax examination, alongside concurrent Toxocara cati, Dipylidium spp., and Giardia duodenalis infections. Hematological findings indicated a systemic inflammatory response. Treatment comprised topical and systemic antiparasitics (esafoxolaner, praziquantel, eprinomectin and fenbendazole), oral antibiotics (cephalexin), antipruritic therapy (prednisolone), and supportive skin care. Follow-up examinations at days 8, 12, 15, and 21 demonstrated progressive clinical improvement, with resolution of mange, endoparasitic infections, otitis, and deep pyoderma by the end of treatment. This case highlights the need for early recognition and comprehensive management of notoedric mange, particularly in stray feline populations. The observed association between N. cati infestation and otitis externa suggests that its role in feline ear disease may be underestimated.