{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:02:34Z","timestamp":1787065354488,"version":"build-2736575974"},"reference-count":5,"publisher":"American Veterinary Medical Association (AVMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["javma"],"published-print":{"date-parts":[[2024,5,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>This is the first reported use of posaconazole for the treatment of feline disseminated histoplasmosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>ANIMALS<\/jats:title>\n                    <jats:p>Approximately 1-year-old female spayed domestic longhair cat.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES<\/jats:title>\n                    <jats:p>The cat presented to our institution with weight loss, lymphadenomegaly, hepatosplenomegaly, limb edema, abdominal fluid distension and ulcerated cutaneous nodules. The cat had been previously diagnosed with disseminated histoplasmosis at another institution approximately 6 months prior. Clinical signs had been refractory to treatment with fluconazole. Itraconazole had next been tried, and the cat\u2019s weight continued to decline, lesions failed to regress, and the cat formed abdominal fluid distension and marked pelvic limb edema.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>TREATMENT AND OUTCOME<\/jats:title>\n                    <jats:p>\n                      The cat was prescribed posaconazole along with prednisolone. The cat\u2019s demeanor, body weight, and lesions all markedly improved.\n                      <jats:italic>Histoplasma<\/jats:italic>\n                      antigen was undetectable in urine samples while the cat was receiving posaconazole. However, posaconazole blood levels paired with markedly elevated ALT suggested potential toxicity and the drug was discontinued. Upon cessation of posaconazole, the cat\u2019s lesions returned with cytologic evidence of intralesional\n                      <jats:italic>Histoplasma<\/jats:italic>\n                      yeast. Itraconazole combine with terbinafine was prescribed. At last follow-up, the cat was clinically well, off all anti-fungal medication, and without detectable\n                      <jats:italic>Histoplasma<\/jats:italic>\n                      antigen in the urine.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CLINICAL RELEVANCE<\/jats:title>\n                    <jats:p>Posaconazole therapy showed promise in this case. Had a safe and therapeutic dose been arrived at, we suspect that posaconazole would have cleared or maintained clinical remission of this cat\u2019s disease. This is the first report using posaconazole and the first successful report using combination itraconazole and terbinafine for the treatment of feline disseminated histoplasmosis. Generic drugs were used throughout this case report; the drug manufacturers are unknown to the authors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2460\/javma.23.12.0677","type":"journal-article","created":{"date-parts":[[2024,2,7]],"date-time":"2024-02-07T13:32:59Z","timestamp":1707312779000},"page":"1-3","source":"Crossref","is-referenced-by-count":1,"title":["Posaconazole followed by combination itraconazole and terbinafine for treatment of disseminated histoplasmosis in a cat"],"prefix":"10.2460","volume":"262","author":[{"given":"Maia V.","family":"Farber-Klein","sequence":"first","affiliation":[{"name":"Department of Veterinary Clinical Sciences, Iowa State University, Ames, IA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin R.","family":"McQuinn","sequence":"additional","affiliation":[{"name":"Department of Veterinary Clinical Sciences, Iowa State University, Ames, IA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1272","reference":[{"issue":"5","key":"ref1","series-title":"J Antimicrob Chemother","first-page":"1162","article-title":"Therapeutic drug monitoring (TDM) of antifungal agents: guidelines from the British Society for Medical Mycology","volume":"69","author":"Ashbee HR","year":"2014","unstructured":"Ashbee HR, Barnes RA, Johnson EM, Richardson MD, Gorton R, Hope WW. Therapeutic drug monitoring (TDM) of antifungal agents: guidelines from the British Society for Medical Mycology. J Antimicrob Chemother. 2014;69(5):1162-1176. doi:10.1093\/jac\/dkt508"},{"issue":"12","key":"ref2","series-title":"J Feline Med Surg","first-page":"841","article-title":"Feline histoplasmosis: fluconazole therapy and identification of potential sources of Histoplasma species exposure","volume":"14","author":"Reinhart JM.","year":"2012","unstructured":"Reinhart JM.. KuKanich KS, Jackson T, Harkin KR. Feline histoplasmosis: fluconazole therapy and identification of potential sources of Histoplasma species exposure. J Feline Med Surg. 2012;14(12):841-848. doi:10.1177\/1098612X12452494"},{"issue":"4","key":"ref3","series-title":"Clin Tech Small Anim Pract","first-page":"227","article-title":"Histoplasmosis in dogs and cats","volume":"20","author":"Br\u00f6mel C","year":"2005","unstructured":"Br\u00f6mel C, Sykes JE. Histoplasmosis in dogs and cats. Clin Tech Small Anim Pract. 2005;20(4):227-232. doi:10.1053\/j.ctsap.2005.07.003"},{"issue":"6","key":"ref4","series-title":"J Vet Intern Med","first-page":"409","article-title":"Itraconazole for the treatment of histoplasmosis in cats","volume":"8","author":"Hodges RD","year":"1994","unstructured":"Hodges RD, Legendre AM, Adams LG,  Itraconazole for the treatment of histoplasmosis in cats. J Vet Intern Med. 1994;8(6):409-413. doi:10.1111\/j.1939-1676.1994.tb03260.x"},{"issue":"5","key":"ref5","series-title":"J Vet Intern Med","first-page":"1703","article-title":"Posaconazole Pharmacokinetics in healthy cats after oral and intravenous administration","volume":"30","author":"Mawby DI","year":"2016","unstructured":"Mawby DI, Whittemore JC, Fowler LE, Papich MG. Posaconazole Pharmacokinetics in healthy cats after oral and intravenous administration. J Vet Intern Med. 2016;30(5):1703-1707. doi:10.1111\/jvim.14523"}],"container-title":["Journal of the American Veterinary Medical Association"],"original-title":[],"link":[{"URL":"https:\/\/avmajournals.avma.org\/view\/journals\/javma\/262\/5\/javma.23.12.0677.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/avmajournals.avma.org\/downloadpdf\/journals\/javma\/262\/5\/javma.23.12.0677.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/avmajournals.avma.org\/downloadpdf\/journals\/javma\/262\/5\/javma.23.12.0677.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,25]],"date-time":"2024-09-25T11:23:55Z","timestamp":1727263435000},"score":1,"resource":{"primary":{"URL":"https:\/\/avmajournals.avma.org\/view\/journals\/javma\/262\/5\/javma.23.12.0677.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,1]]},"references-count":5,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.2460\/javma.23.12.0677","relation":{},"ISSN":["0003-1488"],"issn-type":[{"value":"0003-1488","type":"print"}],"subject":[],"published":{"date-parts":[[2024,5,1]]}}}