Surgical treatment of an intracranial Cryptococcus granuloma in a cat

Summary A 4‐year‐old, female, neutered, domestic short‐haired cat presented with an acute onset of progressive compulsive pacing and obtundation. General physical examination revealed a crusty nasal discharge, with neurological examination showing a forebrain localisation. Magnetic resonance imaging of the brain revealed a large mass in the right frontotemporal region, suggestive of a granuloma, with features of raised intracranial pressure. Fine‐needle aspirate samples from an enlarged retropharyngeal lymph node identified yeast organisms, confirmed as Cryptococcus neoformans , on serological and microbiological testing. Following initial oral fluconazole and prednisolone treatment, the cat deteriorated, and surgical debulking by craniectomy was elected to address signs of raised intracranial pressure. The cat recovered well, and 6 months post‐surgery was neurologically normal, receiving oral fluconazole with markedly reduced cryptococcal antigen titres. These findings suggest that surgical debulking in combination with antifungal therapy can be considered for selected cats with intracranial cryptococcal granulomas and progressive signs.