Hello all,

I posted on here earlier this year asking for some advice about my cat who had a very advanced cryptococcosis infection.
Her right lymph node (submandibular) was swollen the entire time, and the left one but to a lesser degree.

She developed anisocoria and horners syndrome, droopy right eye, and she had a mass that felt like bone on top of her eye.
The anisocoria disappeared after 3 days and her pupils were entirely normal again.

Things escalated last week. Her nose has always been blocked, to various degrees, since she developed the symptoms, 1.5 years ago, but it seemed like she was able to get enough air in with some gasping and mouth breathing. I didn’t know how comfortable she was, but I had to try the last recommendation the vet suggested: 150mg of fluconazole a day. She was on this massive dose for 3 months. (4 kg cat)
Previously, she was on 37.5mg for 6 months, her nose and lesions cleared up and she was able to breathe again (most importantly!)
But, in March, a big lump (cryptococcosis mass) exploded into an abscess. It wouldn’t heal. The vet performed surgery to remove it and other lesions nearby. It was an eyesore, I felt so bad for her. She had a cone on for nearly 3 weeks because the suture area got a bit infected. Raised her fluconazole dose to 75mg a day.

Last week, her nose got much more inflamed and distorted very rapidly. It began bleeding and ulcerating, drying up and then bleeding repeatedly.
She looked so uncomfortable and basically slept all day in various positions to keep her head elevated. When near me or when sleeping with me at night, she’d clamp onto my arm or neck with her teeth to keep her mouth open so she could breathe and fall asleep. I can’t fathom how difficult it was to sleep having to make a conscious effort to get air in through her mouth. I understand cats are not “mouth breathers” and can’t fully relax that way.

I took her in to see her vet, 11 days ago, after noticing blood on her paw, and no wound. The vet looked inside her mouth and looked said the fungus was pushing through her soft palate (roof of mouth) into her front teeth. She recommended euthanasia and said she was not going to “get better” in her professional opinion. And that my cat was suffering and it wasn’t ok, I asked outright if her quality of life was ok. She said no. My cat had lost 1 kg since her last visit. This also factored into the vet’s recommendation.

The vet was ready to put my cat to sleep at the time of our consult, but I requested some time to digest and take her home to say goodbye.
Then, 4 days later, I took her in for euthanasia. I wish I had canceled. Am I wrong to feel that she should have died on her own terms?
What she had was like a breathing disability, in other ways she was a strong and vital cat. She was still eating, though appetite decrease by 30 or 40%.
Why did her nose not clear up (while the cutaneous lesions cleared) and in fact get worse after 3 months on a higher dose?
I’m so devastated and confused and wish I could have done more to save her life.
I felt selfish for letting her live this way, knowing there was no hope and I’d just be prolonging the inevitable (probably suffocation).
I am in so much pain recollecting what’s happened.

I wish I had kept her at home and only taken for euthanasia if she had collapsed and refused to eat. Taking her in to have her put down when she still asked to be fed, showed playfulness in some moments, trotting around when it was food time, it felt hasty but also inevitable. I felt I was saving her from experiencing more suffering as the fungus grew.
But, I will never know how it would have gone if I left her. Maybe nature would have performed a miracle, and she would heal, or she would die without my intervention and without pain (like a quick heart attack). I feel so terrible for having made the choice to snuff out her little life when she was still very strong.
She fought the sedative the vet gave, they took her back to insert a catheter and didn’t bring her to me until 40 mins later, saying she was fighting the sedative.
It pains my heart thinking she was in terror during her last hour on earth. When they carried her in, sedated, she looked absolutely petrified and braced. I could see her spirit fighting with all its might.

The vet told me that she had a more thorough examination of her nose and that the masses had hardened/were like concrete all through her nasal airway and that she was breathing through a “pin prick” hole. She said she was never more certain that euthanasia was the right choice.

I am so heartbroken. I still feel like I took her life away too early. Why should it be up to me? I can barely trust myself now.

Hello all,
Writing in with an agonizing and drawn out struggle with my cat Petra..

I rescued a feral kitten in 2022 who developed cryptococcosis the following year – confirmed through a biopsy.
She has the cutaneous and nasal form, and while we tried itraconazole for a few months, it did devastating damage to her nose.
Vet switched her to fluconazole 37.5 mg (at that time my cat was just over year old and weighed 3.5 kg) once a day… and the symptom relief was remarkable!
Within a month, her nose was much less inflamed and starting to look “relatively normal” again, and best part was she was no longer having difficulty breathing, no stertor or mouth open.
Her many crusty skin lesions and nodules under the skin cleared up miraculously!

But, the success was short-lived, because a couple of months later she developed a big bulge on her abdomen/side under the skin – which eventually erupted. She had had several of these nodules and lumps, that ulcerated last year but the fluconazole seemed to clear them all up. Until now. I was so disheartened, to say the least.
The crater-like ulcer got infected and our vet (RCVS licensed in UK) decided surgery was the best option.
We did this, and the vet found more ulcers which needed to be removed to patch up the skin. It was a horrific looking surgery aftermath when she came home.

Petra required to wear a cone for 3 weeks after her surgery so she couldn’t touch her healing wound. It got infected anyway, and this increased her “cone suffering” duration.
The impact of many vet visits, surgery, and follow ups while the vet checked if the wound was healing and if the stitches could be removed, was quite an ordeal for Petra.
She gets very stressed and is difficult to put in a carrier. I feel that the stress of cone duration + all the vet trips triggered an inflammatory response in her and her nose started showing signs of the fungus again. Inflammation, distortion and worst of all the stertor was back.

The vet increased her fluconazole dose to 75 mg a day (37.5 mg morning, 37.5 mg evening). This had no noticeable effect and her nose got more inflamed as each day went by. 2 months later and her nose is worse than ever and the tip is so inflamed. With the loss of scent and ability to breathe sufficiently, she’s become reluctant to eat more than half a tin of food a day. Sometimes all she will eat is half a tablespoon and then runs off, upset.

Petra’s vet wants to put her on a maximum dose of 150 mg of fluconazole, daily, before assessing her quality of life and potential euthanasia.
I decided to try homeopathic remedies first, while continuing 75 mg a day of fluconazole) but it doesn’t appear to be helping 3 weeks in.

I’m concerned about continuing vet interventions, because Petra is so stressed by them, and at 150 mg a day she will need to see the vet frequently and likely need blood tests. At 150 mg a day, it’s also a non sustainable chunk of my monthly expenses (taken from diminishing savings), and she is not my only cat or responsibility… this could go on for years..

If she has no positive response (symptoms relief) at 150 mg, the vet is out of ideas other than euthanasia. I live in Bahrain and the options for treating this fungus are very limited.
They have not seen it in over 40 years of vet practice, so this is a first time.

I love Petra and it’s been hell witnessing her struggle to breathe for over a year. That’s what makes me panicky and consider quality of life, if she cannot be cured or brought to a level of management where the fungus doesn’t impede her breathing.

I need advice from a community of animal lovers, vets, who can also understand and take into consideration her temperament and adverse reaction (inflammation) to vet visits.

I was really hoping the homeopathic medicine would help and the practitioner I found has many years of successes working with animals. It’s either the wrong remedy, or just going to take a long time. In the meantime, in my opinion, my cat is suffering and struggling. She takes gasps of air every so often and her mouth is slightly open while she makes a snoring sound as she tries to breathe through her blocked airway. She has lost weight as she eats much less now. She was 4.7 kg in April before her surgery. At the beginning of June she was 4.5 kg and now she is closer to 4 kg.
Also within the last 2 months, her eyes have gotten affected by the nodules. One above her right eye, under the skin and affecting the bone. The other is in her left lower eyelid.
During this whole ordeal, her right lymph node under her jaw has been the size of a golf ball.. and the left one also swelled up a few months later. But that side seems to have gone down.

Any help or advice on what to do.. would be very much appreciated.

Pics from most recent (today June 3rd 2024) to last year before fluconazole and way before, late 2022, when she was a kitten.