Case 10

Since Max otherwise seems to be responding well, you recommend decreasing the fluconazole dose to once a day, and you expect to see an improvement in his appetite within the next 48 hours. If Max had not been showing any clinical signs (i.e. no decrease in appetite), the elevation in his liver enzyme activities alone may not have prompted a change in his medication since these elevations often resolve on their own without treatment.

If Max's appetite returns as expected, the plan is to see him again in one week to recheck his hepatic enzyme activities and again two weeks later to reevaluate his thoracic radiographs.

Well, life intervened and Max's owners don't bring him back in for a month. The good news is that the owners report that Max is eating well and that he appears to be steadily improving. They no longer think that he is breathing rapidly, but he does still seem to get winded when playing with the other cat.

Indeed, Max has gained 0.3 lb in the last month. You perform a CBC and serum chemistry profile, and all the results are normal. You also repeat a thoracic radiographic examination, and these are the findings:

Mild to moderate interstitial disease is present. The nodular pattern noted on the previous radiographs has improved but has not completely resolved. The rest of thoracic cavity appears normal.

QUESTION 7

Based on Max 's physical examination and radiographic findings you decide to:

a) Continue the fluconazole, and add amphotericin B.

b) Continue the fluconazole, and start prednisone.

c) Discontinue therapy.

d) Continue the current course of fluconazole, and reevaluate Max in one month.

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