Dear Dr. John,

It seemed our 15-year-old mixed breed short-haired cat developed a swelling on the bridge of her nose in about one or two months along with some sneezing. We didn’t think too much of it until one day she caught one of her long nails on it when she was trying to scratch the area. I was able to dislodge the nail and found a way to trim her nails, something I was always scared to do.

Our vet informed us that she has a fungal infection and due to the size of the bump has scheduled surgery on it and has put her on medication. How common is it to find a fungal infection in this area and how does it happen? Can this just be treated with medication without putting her through surgery? L.B.

Dear L.B.,

I’m hopeful that you are addressing this problem in time since these kinds of infections can spread somewhat rapidly into nearby areas such as the eyes, the brain, and even become systemically problematic. Most commonly, a fungal infection located in this area creates a solid mass and sneezing and nasal discharge is also seen. Given her age, it is easy to be suspicious of a tumor and these also occur and can present in the same way but these fungal infections, while not common, are not too unusual.

Radiographs, swabs, cultures, and biopsies can all be used to identify the cause and make a diagnosis. The most common cause is Cryptococcus which develops from inhaling the spores which can be found in soil or from bird feces, but where a cat gets exposed is not always known. If your veterinarian is suggesting surgery as well as medication, there must be a good reason for doing so such as a large lesion causing secondary breathing or skin issues.

The medications most commonly used are fluconazole or itraconazole depending on the severity. These are typically given to the cat for anywhere from 3-9 months until the infection is completely cleared. In tougher cases, sometimes another drug called amphotericin is used.

Dr. John de Jong is President of the World Veterinary Association. He owns and operates the Boston Mobile Veterinary Clinic and can be reached at 781-899-9994.