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Dermatology for the Small Animal Practitioner
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The Cat with Nodules

Author(s):
Mueller R.S.
In: Dermatology for the Small Animal Practitioner by Mueller R.
Updated:
NOV 23, 2006
Languages:
  • EN
  • ES
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    Read

    Key Questions

    > How old was this patient when clinical signs were first recognized?
    > How long has the disease been present and how did it progress?
    > Are there other clinical signs such as sneezing, coughing, or diarrhea?
    > Was the disease treated before? If so, which drugs were used and how successful was treatment?

    Differential Diagnoses

    The differential diagnoses depend primarily on two features: the number of lesions and whether draining tracts are present or not. Is there only one lesion? This increases the likelihood of neoplasia or a kerion. Or are there multiple lesions? These may be due to sterile inflammatory diseases, more aggressive neoplastic disease, or severe infection. The presence of draining tracts increases the likelihood of foreign bodies, severe bacterial or fungal infection, or sterile inflammatory disease.

    In a cat with nodules, history taking and clinical examination are followed by microscopic evaluation of impression smears (if draining tracts are present) and aspirates (in any cat with nodules). In some patients, cytology will reveal an infectious organism or classic neoplastic cells and thus a diagnosis. In most patients, cytology will aid in further limiting the list of differential diagnoses, but a biopsy will be necessary to reach a diagnosis. With nodular lesions, a complete excision of one or more nodules should be performed. If draining tracts are present and/or cytology indicates possible infection, a tissue culture may be useful as well.

    Table 2-11. Differential Diagnoses, Commonly Affected Sites, and Recommended Diagnostic Tests in a Cat with Nodules

    Disease

    Commonly Affected Sites

    Treatment

    Prognosis

    Neoplasia*

    Varies with individual neoplastic diseases

    Surgical excision and/or tumor specific therapy

    Poor to excellent depending on the individual tumor.

    Abscesses (caused by bite wounds or foreign bodies)

    Fluctuating nodules most commonly around neck, shoulders, and tail base

    Surgical drainage, antibacterial treatment

    Good

    Opportunistic mycobacterial infection* (ubiquitous, facultatively pathogenic organisms such as Mycobacteria fortuitum, M. chelonei, M. smegmatis, cause lesions after traumatic implantation into subcutaneous tissue)

    Nonhealing ulcerated nodules with draining tracts predominantly in the abdominal or inguinal area (Fig. 2-58and Fig.2-59).

    Wide surgical excision followed by combination antimicrobial therapy

    Fair with appropriate surgical approach

    Cryptococcosis* (uncommon infection of sometimes immunocompromised host with ubiquitous, saprophytic, yeast-like fungus Cryptococcus neoformans)

    Upper respiratory, cutaneous, central nervous system, and ocular signs. Firm swelling over the bridge of the nose (Fig. 2-60), papules, nodules, ulcers and draining tracts. Nose, lips, and claw beds may be affected.

    Antimycotic therapy with azoles and/or amphotericin B

    Fair

    Bacterial pseudomycetoma (nonbranching bacteria such as coagulase-positive Staphylococciimplanted by trauma form grains of compact colonies surrounded by pyogranulomatous inflammation; rare disease)

    Firm nodules with draining fistulae (Fig. 2-61)

    Complete surgical excision, postsurgical antibacterial treatment

    Fair with complete excision; guarded, if this is not possible.

    Eumycotic mycetoma (ubiquitous soil saprophytes cause disease through wound contamination; rare disease)

    Nodules with draining tracts and scar tissue. Grains vary in size, shape, and color.

    Wide surgical excision followed by antimycotic therapy based on in vitro susceptibility testing.

    Fair to guarded depending on surgical excision.

    Feline Leprosy* (presumably transmission of an incompletely characterized mycobacterium that is difficult to culture through bite wounds from rats; rare disease in veterinary dermatology)

    Single or multiple, nonpainful and nonpruritic nodules on head and limbs; sometimes ulcers and fistulae are present (Fig. 2-62a and Fig. 2-62b)

    Surgical excision, combination antibiotic therapy

    Fair

    Actinobacillosis* (Oral commensal aerobic Actinobacillus ligneriesii is traumatically implanted, often through bite wounds; rare disease in veterinary dermatology)

    Thick-walled abscesses of the head, mouth, and limbs discharging thick pus with soft yellow granules.

    Surgical excision or drainage and long-term antibacterial therapy with streptomycin, chloramphenicol, sodium iodide or tetracyclines

    Guarded

    Histoplasmosis (uncommon infection with dimorphic, saprophytic soil fungus Histoplasma capsulatum; very rare disease in veterinary dermatology)

    Papules, nodules, ulcers, and draining tracts with concurrent anorexia, weight loss, and fever; dyspnea and ocular disease

    Antimycotic therapy with azoles, possibly in combination with amphotericin B

    Guarded to grave

    Nocardiosis* (Nocardia spp. are soil saprophytes that cause respiratory, cutaneous, or disseminated infections; very rare disease in veterinary dermatology)

    Ulcerated nodules and abscesses, often with draining tracts, on the limbs and ventral abdomen

    Surgical drainage, antibacterial therapy based on in vitrosusceptibility testing.

    Guarded

    Phaeohyphomycosis* (wound contamination by ubiquitous saprophytic fungi with pigmented hyphae; very rare disease in veterinary dermatology

    Often solitary subcutaneous nodules on nose, trunk, or extremities

    Wide surgical excision followed by antimycotic therapy based on in vitro susceptibility testing.

    Guarded

    Plague (infection with Yersinia pestisby inhalation of organism or through wound contamination or flea bites; very rare disease in veterinary dermatology)

    Zoonosis: Spread through transmission of infected fleas, presentation of infected killed rodents, or direct infection!

    High fever, depression, anorexia, and abscesses typically on the face or limbs in the bubonic form. Septicemic and pneumonic forms also exist.

    Flea control, draining of abscesses, antibacterial therapy with tetracycline, streptomycin, or chloramphenicol

    Fair, if recognized and treated promptly.

    Sporotrichosis* (caused by ubiquitous dimorphic fungal saprophyte Sporothrix schenkii that infects wounds; uncommon disease in veterinary dermatology)

    Zoonosis: Transmission to humans through contact with an ulcerated wound easily possible!

    Multiple nodules or ulcerated plaques on the head, distal limbs, tailbase (Fig. 2-63). Anorexia, lethargy, fever, and depression possible concurrently

    Antimycotic therapy with iodides or azoles

    Fair

    Sterile granulomatous and pyogranulomatous disease (unknown pathogenesis)

    Firm, painless, nonpruritic dermal papules, plaques, and nodules typically on head and pinnae

    Doxycycline / Niacinamide, immunosuppressive therapy, may resolve spontaneously

    Fair

    Sterile panniculitis (unknown pathogenesis)

    Solitary nodules on ventral rump

    Surgical excision

    Good

    Tuberculosis* (very rare in small animal dermatology; predominantly respiratory and digestive lesions)

    Insidious ulcers, plaques, and nodules on head, neck, and limbs discharging yellow-green pus with unpleasant odor

    Combination antimicrobial therapy, frequent euthanasia (public health concerns)

    Poor

    A 5-year-old castrated domestic shorthair (DSH) with nodules and draining tracts resulting from atypical mycobacteria
    Figure 2-58. A 5-year-old castrated domestic shorthair (DSH) with nodules and draining tracts resulting from atypical mycobacteria (Courtesy of Dr. Sonya Bettenay).

    Draining tracts due to atypical mycobacteria in a 3-year-old castrated DSH
    Figure 2-59. Draining tracts due to atypical mycobacteria in a 3-year-old castrated DSH.

    Nasal swelling caused by cryptococcosis in a 6-year- old female domestic long-hair cat
    Figure 2-60. Nasal swelling caused by cryptococcosis in a 6-year- old female domestic long-hair cat. (Courtesy of Dr. Thierry Olivry).

    Pseudomycetoma in a Persian cat
    Figure 2-61. Pseudomycetoma in a Persian cat (Courtesy of Dr. Peter Ihrke).

    Feline leprosy in a DSH
    Figure 2-62a. Feline leprosy in a DSH (Courtesy of Dr. Peter Ihrke).

    Close up of feline leprosy in a DSH
    Figure 2-62b. Close up of feline leprosy in a DSH (Courtesy of Dr. Peter Ihrke).

    Nasal ulceration in a 2-year-old castrated DSH with sporotrichosis
    Figure 2-63. Nasal ulceration in a 2-year-old castrated DSH with sporotrichosis.

    The cat with nodules
    Figure 2-64. The cat with nodules.

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    About

    How to reference this publication (Harvard system)?

    Mueller, R. (2006) “The Cat with Nodules”, Dermatology for the Small Animal Practitioner. Available at: https://www.ivis.org/library/dermatology-for-small-animal-practitioner/cat-nodules (Accessed: 25 March 2023).

    Affiliation of the authors at the time of publication

    Department of Clinical Sciences Coll. of Veterinary Medicine & Biomedical Sciences, Colorado State University, Fort Collins, CO, USA.

    Author(s)

    • RS Mueller

      Mueller R.S.

      Dr Med Vet, MACVSc Dipl ACVD FACVSc
      Medizinische Kleintierklinik, Ludwig-Maximilians Universität München
      Read more about this author

    Copyright Statement

    © All text and images in this publication are copyright protected and cannot be reproduced or copied in any way.
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