Fatal disseminated Toxoplasma gondii infection in a cat from Madrid, Spain

Case summary Toxoplasma gondii is a globally distributed apicomplexan protozoan infecting all warm-blooded animals. Cats are the definitive host, susceptible to clinical disease. In Spain, studies have shown the widespread presence of Toxoplasma IgG antibodies in cats but there are no published data on clinical toxoplasmosis in cats from Spain. We describe a case of fatal disseminated toxoplasmosis in a 7-year-old outdoor domestic shorthair cat. The cat, an active hunter, was presented with a 1-week history of malaise and acute deterioration over 24 h. Fever, tachypnoea and abdominal discomfort were detected on physical examination. No evidence of immunosuppressive disease or previous treatment could be found. A moderate increase in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) was found on serum biochemistry. Radiography revealed hepatomegaly and a small patchy pulmonary alveolar pattern in the caudal lung lobes. In 48 h, the AST and ALT levels were severely increased and the cat's respiratory signs worsened. Parenteral clindamycin administration (25 mg/kg IV q12h) and supportive treatment could not prevent progression to death. Cytology from the liver and lungs revealed organisms morphologically consistent with T gondii. Indirect immunofluorescence antibody test Toxoplasma titres were 1:100 IgM and 1:100 IgG. PCR performed on scraped material from glass cytology slides was positive for T gondii in both lung and liver aspirates.Relevant and novel information To the authors' knowledge, this is the first case of fatal disseminated toxoplasmosis in a cat described in Spain, confirmed by PCR. Fine-needle aspirates from the liver could assist in the diagnosis of fatal disseminated toxoplasmosis when liver enzymes are increased.