Pulmonary candidiasis caused by Candida albicans in a Greek tortoise (Testudo graeca) and treatment with intrapulmonary amphotericin B

An adult female Greek tortoise (Testudo graeca) presented with dyspnea, lethargy, and anorexia. Severe unilateral pulmonary candidiasis was diagnosed and confirmed by histologic and microbiologic evaluations. Initial treatment with ketoconazole resulted in plasma elevations of aspartate aminotransferase, lactate dehydrogenase, and bile acids consistent with imidazole-induced hepatotoxicity. Plasma chemistry abnormalities resolved upon withdrawal of the drug. Temporary osteotomy permitted access to the diseased lung and facilitated intrapulmonary catheterization. Intrapulmonary amphotericin B therapy at 0.1 mg/kg s.i.d. for 34 days proved to be both safe and effective in this case.