Abstract

An 80-year-old male Galapagos tortoise (Chelonoidis nigra) presented for progressive lethargy and hyporexia of 8 months duration and recent onset nasal discharge. Prior to presentation, the patient was treated with fenbendazole, metronidazole, and ceftazidime. Initial blood work showed presence of fibrin strands on blood film review, severe nonregenerative anemia, and chronic-active inflammation. A large pulmonary lesion was identified radiographically, and significant right sided bronchitis and pulmonary exudate was noted on bronchoscopy. Trans-carapacial pulmonoscopy was performed, and a large encapsulated mass was identified in the craniodorsal right lung field. The mass was sampled for bacterial and fungal culture, cytology, and histopathology, and an intralesional transcarapacial port was placed. Cytology and histopathology identified granulomatous and heterophilic inflammation with low numbers of fungal hyphae. Universal fungal primer PCR and sequencing of both culture and tissue revealed a novel organism. Bayesian and maximum likelihood phylogenetic analysis placed it with the genus Nannizziopsis, representing an undocumented species. The organism showed susceptibility to several antifungal agents, including itraconazole and terbinafine. The tortoise was managed in the hospital for 3 weeks on amphotericin B^a through intralesional port, intraosseous fluids, esophageal tube feedings, itraconazole^b, terbinafine^c, hydromorphone^d, metronidazole^e, vitamin K^f, and neomycin, polymyxin, and bacitracin ophthalmic ointment^g. The patient was discharged from the hospital on itraconazole and terbinafine, and is doing well 6 months after discharge from the hospital. Given the emergent nature of this genus of fungal pathogens, this case report expands our knowledge base about this clinically important clade of organisms.¹

^a0.1 mg/kg topically/intralesional through carapacial port q48h, 10 days, Fungizone, X-Gen Pharmaceuticals Inc., Horseheads, NY, 14845.
^b6.5 mg/kg, po, sid, Sporanox, Par Pharmaceutical, Chestnut Ridge, NY, 10977.
^c3.8 mg/kg, po, sid, Generic, Harris Pharmaceutical, Inc. Fort Meyers, FL, 33908.
^d0.04 mg/kg, io or im, sid, 8 days, Dilaudid, Hospira, Inc., Lake Forest, IL, 60045.
^e5.4 mg/kg, po, q48h, for 7 days, Flagyl, Unichem Pharmaceuticals Inc., Hasbrouck Heights, NJ 07604.
^f1 mg/kg with IV fluids, q48h for three treatments, Sparhawk Laboratories Inc., Lenexa, KS 66215.
^gTopical ophthalmic ointment OS q8h, 10 days, Generic, Akorn, Inc., Lake Forest, IL 60045.

Acknowledgements

The authors would like to thank the large and small animal veterinary technicians at the University of Florida College of Veterinary Medicine for their exceptional care in the management of this tortoise.

Literature Cited

1.  Paré JA, Sigler L. An overview of reptile fungal pathogens in the genera Nannizziopsis, Paranannizziopsis, and Ophidiomyces. J Herpetol Med Surg. 2016;26:46–53.