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A 12-year-old male neutered Tonkinese cat was presented for acute ataxia, weakness, altered mentation and generalised tremors. The cat had been administered oral spinosad (140 mg; 33.5 mg/kg) 48 h prior to the onset of clinical signs, and an oral anthelmintic containing milbemycin oxime (16 mg; 3.8 mg/kg) and praziquantel (40 mg; 9.6 mg/kg) 12 h before the onset of clinical signs. On physical examination, dull-to-obtunded mentation, tetraparesis, ataxia and mild tremors of facial, limb and trunk muscles were noted. Serum biochemical changes and urinalysis were consistent with haemoconcentration. The results of a complete blood count, urine culture and serology for feline leukaemia virus, feline immunodeficiency virus and cryptococcal antigen were negative. The patient was monitored in hospital and all clinical signs resolved within 24 h.
Relevance and novel information
The neurological signs in this case were consistent with macrocyclic lactone neurotoxicity, which is suspected to have occurred from an adverse drug interaction between spinosad and milbemycin oxime. This report serves to highlight the potential for this adverse drug interaction between these commonly used prophylactic drugs.
A 14-month-old castrated male domestic shorthair cat presented with an 8 month history of severe pruritus, alopecia, papules and excoriations. Initial evaluation and treatment prior to referral included skin scrape, cytology, two strict food trials, dermatophyte culture, and bacterial culture and sensitivity, as well as antibiotic therapy, empiric treatment for mites, steroids and ciclosporin A (Atopica; Elanco). The cat was referred to the Dermatology and Otology Clinic at the University of Illinois Veterinary Teaching Hospital for further diagnostics and treatment. Skin scrapes were unremarkable. Cytology showed rare bacteria and moderate neutrophils. The cat was given an injection of triamcinolone acetonide, which was ineffective. Oclacitinib (Apoquel; Zoetis) was given for 4 weeks with no improvement. A skin biopsy was performed, and histopathology showed large numbers of well-differentiated monomorphic mast cells with fewer eosinophils that diffusely infiltrated the superficial dermis, supportive of urticaria pigmentosa. Oral dexamethasone and cetirizine hydrochloride were initiated, and the cat responded favorably. At the time of writing, the cat continues to do well on cetirizine hydrochloride with only intermittent tapering courses of dexamethasone.
Relevance and novel information
To the best of our knowledge, this is the first reported case of urticaria pigmentosa in a domestic shorthair cat. This case also highlights the importance of biopsy after a thorough, systematic work-up in a cat with severe, intractable pruritus to reveal an uncommon disease pattern, as well as the efficacy of oral dexamethasone and cetirizine hydrochloride as a potential management option.
This case series describes two cats diagnosed with oesophageal obstruction due to trichobezoars. Both cases presented for acute dyspnoea, with thoracic radiographs revealing changes consistent with oesophageal foreign material causing ventral displacement of the trachea. Endoscopic removal was unsuccessful and both cases required surgical intervention. Case 1 died within 24 h of trichobezoar removal, likely from aspiration pneumonia. Case 2 developed laryngeal collapse 10 days after trichobezoar removal and required a permanent tracheostomy. Case 2 has been followed up for >1 year without any further complications.
Relevance and novel information
There is minimal published information on oesophageal trichobezoars in cats. These cases provide information on presentation, radiographic findings and complications associated with oesophageal trichobezoars. The intention of this case series is to increase the index of suspicion for this syndrome among clinicians treating feline patients.
An 11-month-old female neutered Ragdoll cat was presented for focal seizures, aggression and altered behaviour. A diagnosis of a nasal dermoid cyst with intracranial extension was made following MRI, cytology and histopathology. The cyst was surgically excised with a resolution of clinical signs, with the exception of ongoing seizure activity requiring anti-seizure medication.
Relevance and novel information
To our knowledge, this is the first reported case of a nasal dermoid cyst in a cat, and the first reported case in the veterinary literature of any species with a nasal dermoid cyst presenting with neurological signs.
A 13-year-old spayed female domestic shorthair cat presented with pleural effusion and suspected triaditis. Intake vitals and leukocytosis were consistent with a diagnosis of systemic inflammatory response syndrome. Biochemical analysis confirmed a pleural fluid-to-serum bile ratio consistent with a diagnosis of biliothorax. Abdominal ultrasound failed to identify a definitive gall bladder but noted a hypoechoic tubular structure ventral to the liver and contacting the diaphragm. Thoracic ultrasound identified a hyperechoic structure contacting the diaphragm at the same location. Thoracoabdominal CT scan identified a fluid-dense tubular structure extending from ventral to the liver, through a diaphragmatic defect and directly communicating with the pleural space, suspected to be an abnormal gall bladder. The cat was humanely euthanized, and post-mortem analysis confirmed a cholecystopleural fistula arising from the gall bladder with multifocal abscesses, mixed inflammatory hepatic infiltrates and small-cell gastrointestinal lymphoma. Culture of the abscess isolated Parabacteroides merdae, meeting the reported feline criteria for sepsis.
Relevance and novel information
To our knowledge, spontaneous cholecystopleural fistula formation leading to biliothorax and sepsis has not been previously reported in the cat. This case highlights a novel sequela of gall bladder disease in this species, and biliothorax should be a differential diagnosis for pleural effusion in cats with evidence of cholecystitis or triaditis.
A 3-year-old spayed female domestic shorthair cat developed a fever 1 week after starting the anticonvulsant phenobarbital. A diagnostic work-up for seizures and subsequent onset of fever of unknown origin, consisting of MRI of the brain, cerebrospinal fluid analysis and infectious disease testing, was unremarkable. The cat was switched from phenobarbital onto pregabalin with complete resolution of the fever within 24 h, consistent with a drug-induced fever following phenobarbital administration.
Relevance and novel information
While anticonvulsant hypersensitivities have been reported and studied in veterinary medicine, phenobarbital-induced fever outside of the context of systemic clinical signs has not been documented in the veterinary scientific literature. Drug-induced fever secondary to anticonvulsants should be considered in patients that develop a fever after starting anticonvulsant therapy with an unrewarding diagnostic work-up for fever of unknown origin.
A 9-month-old male domestic longhair cat presented following iatrogenic ureteral trauma after an attempted laparoscopic ovariectomy. Prior to identifying that the cat was male, both ureters were transected approximately 4 mm from the renal pelves. Initial management involved a left-sided Boari flap neoureterocystostomy, cystonephropexy and right ureteronephrectomy. Thirty-six hours later, the cat developed uroabdomen due to leakage from the neoureterocystostomy site. At a tertiary referral institution, the ureter was reconstructed via end-to-end anastomosis and a left-sided subcutaneous ureteral bypass (SUB) device was placed in the event the anastomosis failed. Five weeks after SUB placement, the cat was dysuric and stranguric. A urine culture was negative and clinical signs were attributed to sterile cystitis secondary to device placement. Blood urea nitrogen (BUN) was 22 mg/dl and creatinine was 1.2 mg/dl. Contrast pyelography confirmed device patency, but no contrast was identified through the ureteral anastomosis. At 12 months, BUN and creatinine were 1.5 mg/dl and 25 mg/dl, respectively, and a subclinical urinary tract infection was identified (Enterococcus faecalis). Antibiotic therapy was not prescribed in order to prevent multidrug resistance. At 42 months, BUN was 38 mg/dl and creatinine was 2.0 mg/dl. The cat had occasional and intermittent signs of pollakiuria and stranguria but was otherwise doing well.
Relevance and novel information
To our knowledge, this is the first case report to describe the use of a SUB device for management of traumatic proximal ureteral injury in a cat with one kidney. The case outcome provides valuable information about the direct effect of the SUB device and the presence of chronic Enterococcus species infection on long-term renal function.
A 10-year-old male neutered domestic shorthair cat was presented with a 4 month history of slow, progressive swelling and intermittent multifocal bleeding of the distal right forepaw that progressively developed after cephalic vein catheterisation for anaesthesia. The procedure was performed for dental calculus removal. Initial clinical and biopsy (superficial biopsy) findings matched two differential diagnoses: progressive angiomatosis and acquired peripheral arteriovenous fistula (AVF). AVF was suspected based on Doppler ultrasound examination that identified multiple abnormal sinusoidal neoformed branching vessels with turbulent high-velocity flow spectrum at the confluence of the artery and vein, and high-velocity arterialised flow in the vein. Owing to rapid and severe progression of lesions after biopsy, the owner requested amputation of the cat’s limb. A definitive diagnosis of acquired iatrogenic peripheral AVF was based on deep-tissue microscopical evaluation. High numbers of arterioles and venules in superficial and deep dermis embedded in oedematous stroma were connected to dilated and tortuous vessels with irregularly thickened walls in deep dermis and panniculus. Vasculitis and vascular thrombosis and thickening (attributed to local hypertension) were common findings. No bone or muscular invasion were observed. The cat was doing well 3 years after surgery.
Relevance and novel information
This report describes a case of iatrogenic acquired peripheral AVF following venous catheterisation in a cat, fully documented for the first time by a combination of clinical findings, ultrasound imaging, complete histopathology and follow-up history.
A 1-year-old male neutered cat was presented with a right-sided swelling of the floor of the oral cavity, causing dysphagia and hypersialorrhoea for 2 months. Fine-needle aspiration of the mass and CT were suggestive of a right sublingual sialocoele with no obvious cause. Surgical resection of the ipsilateral sublingual–mandibular salivary gland complex, as well as marsupialisation of the mucocoele, was performed. The cat recovered uneventfully. Histopathological examination of the resected specimen confirmed the diagnosis. No sign of recurrence was reported 7 months after surgery.
Relevance and novel information
Overall, sialocoeles are rare in cats but sublingual mucocoele is the most common form. Diagnosis is usually straightforward and the use of CT to help localise the affected site and possibly identify a cause has been infrequently described. Surgical treatment recommendations have been updated, which also makes a refresher of this uncommon condition likely to be of interest to the feline practitioner.
A 16-year-old domestic shorthair cat was evaluated for acute-onset right pelvic limb monoparesis localized to the sciatic nerve. MRI revealed a homogeneously contrast-enhancing, well-demarcated mass effacing the right sciatic nerve from its intravertebral origin to the end of the viewable field (mid-femur). Abdominal ultrasound revealed thickened small intestinal loops and enlarged mesenteric lymph nodes. Cytology of the small intestine was suggestive of lymphosarcoma. T-cell lymphosarcoma of the sciatic nerve and small intestines was confirmed with incisional biopsy. Treatment consisted of systemic chemotherapy with vincristine followed by the Wisconsin–Madison feline lymphosarcoma protocol, but despite treatment the patient neurologically worsened and was euthanized after 54 days.
Relevance and novel information
We present herein one of the first descriptions of neurolymphomatosis in the domestic cat that included post-intravenous contrast MRI. Treatment options based on recommendations for people with neurolymphomatosis include systemic chemotherapy, intrathecal chemotherapy and/or localized radiation chemotherapy. The authors recommend that all cats be screened for concurrent non-neuronal areas of lymphosarcoma before undergoing treatment for neurolymphomatosis, regardless of clinical signs.
A 9-year-old male neutered domestic longhair cat was presented with a 3 week history of lethargy and pain of unknown origin. A large extra-axial mass was demonstrated on MRI of the head, with cribriform plate destruction, extensive nasal invasion and intracranial expansion, producing a severe mass effect. The mass was isointense on T1-weighted imaging, predominantly hypointense with some hyperintense areas on T2-weighted imaging and fluid attenuation inversion recovery, markedly contrast enhancing, and caused transtentorial and cerebellar herniation. Histopathological evaluation confirmed a transitional (mixed) meningioma.
Relevance and novel information
To our knowledge this is the first report of a meningioma with extensive nasal involvement in a cat. Based on this case, meningioma should be considered as a differential diagnosis for tumours involving the nasal cavity and frontal lobe with cribriform plate destruction.
A 14-year-old female neutered Persian-cross cat was presented with a 1 week history of anorexia and lethargy. On physical examination, marked tachypnoea and dyspnoea were evident. Radiographs of the thorax revealed a globoid-shaped cardiac silhouette with heterogeneous opacity consistent with a peritoneopericardial diaphragmatic hernia (PPDH), pulmonary nodules compatible with metastasis, seven sternal segments and a small liver in the cranial abdomen with loss of serosal detail. On echocardiography, there was no evidence of cardiac tamponade. Triple-phase CT angiography demonstrated a mixed soft tissue-, mineral- and fat-attenuated liver mass arising from the left hepatic lobes that showed a pronounced heterogeneous contrast-enhancement pattern within the pericardial sac, which was producing a marked mass effect on the adjacent structures. Additionally, there was an increase in attenuation of the mesenteric fat and peritoneal effusion. The pulmonary nodules were confirmed. Imaging findings were compatible with a malignant hepatic neoplasia incarcerated in a PPDH, lung metastasis and carcinomatosis. Owing to the poor prognosis, the cat was humanely euthanased. Histopathological diagnosis was cholangiocellular carcinoma and hepatic myelolipoma, pulmonary metastasis and carcinomatosis.
Relevance and novel information
Hepatic cholangiocarcinoma incarcerated in a PPDH with pulmonary metastasis and carcinomatosis has not been previously described. Suspicion of a hepatic neoplasia should be raised in cases of PPDH and pulmonary nodules.
A 10-year-old castrated male domestic shorthair cat presented with a 6 month history of diarrhoea that responded poorly to medical treatment. Ultrasonography revealed moderate thickening of the colonic wall (4.8 mm) and right colic and jejunal lymphadenomegalies. Endoscopic examination revealed partial circumferential narrowing of the transverse colon and friable colonic mucosa with multiple haemorrhagic regions. Histopathological and immunohistochemical examinations revealed a large number of Escherichia coli phagocytosed by periodic acid–Schiff-positive macrophages. Bacterial culture also yielded enrofloxacin-sensitive E coli. The cat was initially treated with prednisolone, which resulted in little improvement. Following histopathological examination and bacterial culture, treatment with enrofloxacin was commenced. Antibacterial therapy resulted in remission of the diarrhoea and an increase in body weight within 14 days.
Relevance and novel information
Granulomatous colitis (GC) or histiocytic ulcerative colitis has been rarely described in cats. There has only been one previously published case study involving a cat, and the aetiology remains largely unknown. The current article describes the regression of E coli-related GC following antibacterial treatment in a cat. Clinical signs, histopathological appearance and response to enrofloxacin were similar to those in canine GC. The current findings suggest that E coli also plays an important role in the development of feline GC.
The aim of this study was to determine the presence and prevalence of heartworm infection in the feral cat population of Grand Cayman.
Methods
During the study period, feral cats were routinely trapped and euthanized for population control by the municipal animal shelter. Cats older than 6 months of age were obtained for post-mortem examination shortly after euthanasia. The heart, lungs, pulmonary vasculature, thoracic and abdominal cavities were examined for the presence, location and number of mature heartworms. Sections of caudal lung were evaluated histologically and serologic tests were performed to screen for additional evidence of heartworm exposure.
Results
Mature heartworms were identified in the pulmonary vasculature of 4/36 cats (11.1%). An additional nine cats showed histopathologic changes in the lungs consistent with heartworm exposure, and one cat had a positive antibody test.
Conclusions and relevance
The results indicate a minimum heartworm prevalence of 11.1% within this population of feral cats, consistent with published necropsy reports from other endemic localities. Considering the histopathologic changes observed in this group, the true prevalence is likely higher and underscores the importance of heartworm prevention for the companion cat population of the island.
An adult cat presented with neurological signs and marked icterus. Clinical pathology tests detected increased serum alkaline phosphatase levels, as well as alanine aminotransferase, total bilirubin, unconjugated bilirubin and conjugated bilirubin above the normal reference intervals. Ultrasonography showed hepatomegaly and a dilated gall bladder. Following these results, the cat was referred for a cholecystectomy owing to a clinical suspicion of obstructive cholecystitis. The animal died in the postoperative period and was referred for necropsy. Grossly, the animal had marked icterus. On the cortical surface and in the brain parenchyma there were marked yellowish areas. The liver was diffusely reddish-orange, enlarged and the capsular surface was slightly irregular. The gall bladder was absent. At its anatomical site and surrounding the common hepatic duct, a whitish nodular neoplasia of 2.0 cm was found. Microscopically, a cholangioma was diagnosed in the region of the common hepatic duct. In the white matter of the cerebellar vermis, there was axonal degeneration associated with gliosis. In the Purkinje neuron layer there was slight multifocal necrosis. Some neurons contained amorphous and brownish pigment (bilirubin) in the cytoplasm. Clinical and pathological findings indicated hepatic and post-hepatic icterus from obstructive cholangioma, resulting in kernicterus.
Relevance and novel information
Kernicterus is a neurological disorder that is rarely diagnosed in animals, especially in adults. This report provides evidence that kernicterus can occur in adult cats, secondary to increased unconjugated and conjugated bilirubin concentrations.
An 8-year-old spayed female domestic shorthair cat was referred for trismus of progressive onset, which had started at least 1 month previously. The patient presented with weakness, anorexia, chronic bilateral purulent nasal discharge and concurrent reduced nasal airflow. Upon physical examination, painful mouth opening, bilateral swelling of the temporal areas, with an inability to open and close the mouth completely, were apparent. A vertical mandibular range of motion (vmROM) of 22 mm was noted. Complete blood count, biochemistry, electrolytes and various serology tests were unremarkable. CT revealed multiple mineralised lesions within the masticatory muscles. Histopathological features were consistent with those seen in the human disease fibrodysplasia ossificans progressiva (FOP). Supportive treatment did not improve the vmROM, eventually resulting in a 13 mm open bite, and total inability to close and open the mouth. Cardiac arrest occurred at the induction of an anaesthesia procedure aiming to perform tracheostomy and nasal lavage. Despite emergency tracheotomy and cardiac resuscitation, humane euthanasia was elected by the owners. Post-mortem molecular investigations highlighted a heterozygous deletion, compatible with a splicing site mutation in ACVR1, which is also associated with FOP in humans.
Relevance and novel information
This is the first report in the veterinary literature of FOP-like disease selectively affecting the masticatory muscles. This condition is associated with a poor prognosis, as no medical or surgical treatment has currently proven to be of any prophylactic or curative benefit. Although rare, FOP-like disease should be included in the differential diagnosis of trismus in the cat. Any further muscle injury should be avoided.
It is described a case of a 10-month-old female mixed-breed cat with left ear discharge of approximately 6 days’ duration prior to the admission. Secretions were collected from both ears using a sterile swab for cytological and mycological analysis. A pyogranulomatous inflammatory infiltrate (predominantly characterized by the presence of neutrophils and macrophages) with the presence of cocci, rods and many yeast-like structures were seen on cytological analysis; the fungal culture confirmed the presence of the Sporothrix schenckii complex. Upon diagnosis of fungal otitis due to the S schenckii complex, treatment with oral itraconazole was administered. After 4 weeks of treatment, no S schenckii complex colonies were isolated, and clinical recovery had occurred.
Relevance and novel information
Although rare, clinicians must be aware of atypical presentations of sporotrichosis, as in this case of external otitis. This is of clinical relevance because this infection has been reported in several countries and is defined as a zoonotic disease.
Two 13-year-old domestic shorthair cats were diagnosed with unilateral right adrenocortical carcinomas (ACCs) and primary hyperaldosteronism (PHA). Both had polyuria, polydipsia and weight loss, and developed severe anaemia from an episode of acute adrenal haemorrhage. In one case, this occurred during hospitalisation and treatment of severe muscle weakness with cervical ventroflexion, while the other cat had acute collapse at home. A diagnosis of PHA was confirmed in both cases based on measurement of plasma aldosterone and renin activity. In one case, basal progesterone was also measured and was elevated. On ultrasonography and CT in one case, haemorrhage into the right retroperitoneal space was identified. Unilateral adrenalectomy was performed in both cases and there was no evidence of venous tumoral invasion in either. On histopathology of the excised adrenal glands both were ACCs with tumour necrosis, and one had extensive intratumoral haemorrhage. Both cats were diagnosed with International Renal Interest Society stage 2 or 3 chronic kidney disease postoperatively; one survived for 18 months and the other was well 8 months postoperatively.
Relevance and novel information
Acute adrenal haemorrhage secondary to adrenal neoplasia has been reported in only one other cat, in which tumour type and function were not specified. Acute adrenal haemorrhage can occur as a consequence of tumour necrosis and rupture and can cause severe hypovolaemia and anaemia in cats with primary hyperaldosteronism.
A 7-year-old female entire Birman presented with acute-onset haemorrhagic vulvar discharge. Moderate, normocytic, normochromic, non-/pre-regenerative anaemia, along with a moderate mature neutrophilia, were seen on haematology. Saline test for agglutination was positive. No haemotropic mycoplasmas were identified. Serum biochemistry revealed severe hyperbilirubinaemia. Retroviral testing was negative. Serology for toxoplasmosis revealed a titre of 1:512. Abdominal ultrasound identified a large uterus, containing at least three advanced-stage fetuses, two of which failed to exhibit independent motion or cardiac activity. Ovariohysterectomy was performed. Histology demonstrated mild, multifocal suppurative placentitis, with Gram staining revealing no evidence of bacteria. Complete resolution of the anaemia was seen within 1.5 months of ovariohysterectomy.
Relevance and novel information
Immune-mediated haemolytic anaemia (IMHA) in association with pregnancy has not been previously reported in cats. This case represents a potential novel cause for IMHA in cats, which resolved following ovariohysterectomy.
A 12-year-old neutered male onychectomized Ragdoll cat presented for a 3 day history of swelling and hemorrhagic purulent discharge on the first digit of the left manus. Radiographs revealed fragments of the third phalangeal bone (P3) present in the partially amputated digits with swelling adjacent to the P3 fragment on the first digit of the left manus. Thoracic radiographs revealed no evidence of primary or metastatic neoplasia. Surgery was performed to remove all P3 fragments and the associated swelling on the diseased digit. On gross examination of the excised swelling, a mass was present at the cut edge of P3. The bone fragment and associated mass were submitted for histopathological evaluation. Osteosarcoma was diagnosed. Because neoplastic cells extended to the surgical margins, amputation of the left thoracic limb was performed. The cat recovered from surgery, and survival time at the time of writing was 8 months.
Relevance and novel information
To our knowledge, this is the first reported case of onychectomy-associated osteosarcoma. Trauma from partial P3 amputation during onychectomy is suspected to have played a role in osteosarcoma development in this case. Malignant transformation may be considered a potential complication of onychectomy achieved by partial P3 amputation.
A 14-year-old neutered female Burmese cat was referred for investigation of a caudal oropharyngeal mass. CT showed a thin walled cyst-like structure filling and expanding from the right tympanic bulla. Histopathology showed fragments of mildly dysplastic squamous epithelium and aggregates of keratin. These findings were considered consistent with a diagnosis of cholesteatoma.
Relevance and novel information
To the best of our knowledge, this is the first reported case of a cholesteatoma in a cat. Cholesteatoma should be considered a differential diagnosis for cats presenting with a caudal oropharyngeal mass, a history of chronic ear disease or a history of previous, surgically managed middle ear disease. Advanced imaging and biopsies should be considered important in the diagnosis of these lesions.
A 14-year-old male neutered domestic mediumhair cat presented with a 4 month history of inappetence and weight loss. Pertinent abnormalities on haematology and biochemistry included a mild microcytic regenerative anaemia (packed cell volume [PCV] 24% [reference interval (RI) 30–45%], mean cell volume 30.8 fl [RI 40–45 fl], absolute reticulocyte count 326.8 × 1012) and increased alkaline phosphatase activity (76 IU/l; RI <50 IU/l). Abdominal ultrasound and CT scan revealed masses in the transverse colon (2.0 cm × 1.2 cm) and right medial liver lobe (5.0 cm diameter). Thoracic radiographs were unremarkable. Right medial liver lobe resection and colectomy were performed. Immunohistochemistry was positive for S-100 protein, vimentin and glial fibrillary acidic protein, very weakly positive for c-kit and negative for muscle-specific actin and CD18, consistent with a colonic malignant peripheral nerve sheath tumour (MPNST) with a hepatic metastasis. Postoperative treatment with metronomic cyclophosphamide was well tolerated. Eighteen months postoperatively the cat re-presented after 3 days of progressive lethargy and inappetence. Haematology revealed a marked non- or pre-regenerative anaemia (PCV 10%). Coagulation times were prolonged (prothrombin time 39 s [RI 15–22 s] and activated partial thromboplastin time >300 s [RI 65–119 s]). Abdominal ultrasound identified multiple renal and hepatic nodules. Euthanasia was performed and post-mortem examination confirmed metastasis of the MPNST.
Relevance and novel information
This report describes the treatment of a metastatic colonic peripheral nerve sheath tumour in a cat. Feline visceral MPNSTs are rare and little is known about prognosis or optimal treatment.
Exogenous lipid pneumonia with mineralisation of the lung parenchyma was diagnosed in three cats with radiographs, CT and/or bronchoalveolar lavage cytological findings. All three cats had a common clinical history of chronic constipation and long-term forced oral administration of mineral oil. All three cases showed radiographic findings compatible with aspiration pneumonia, with an alveolar pattern in the ventral part of the middle and/or cranial lung lobes. Minor improvement of the radiographic lung pattern in the follow-up studies was seen in two cats, and a miliary ‘sponge-like’ mineralised pattern appeared in the previously affected lung lobes months to years after the diagnosis. In one cat, patchy fat-attenuating areas in the consolidated lung lobes were present on thoracic CT. Cases 1 and 2 showed respiratory signs at the initial presentation, while in case 3 the radiographic findings were incidental and the cat had never exhibited respiratory signs.
Relevance and novel information
This is the first report to describe dystrophic mineralisation of the lung in exogenous lipid pneumonia and also the first to describe the CT features in cats. Exogenous lipid pneumonia should be included in the differential diagnosis in cases of miliary ‘sponge-like’ mineral opacities in the dependent part of the lung lobes on thoracic radiographs or CT in cats, especially in cases of chronic constipation, previously exposed to mineral oil.
A 6-month-old male domestic shorthair cat presenting with abdominal distension and an acute history of renal azotemia was diagnosed with bilateral perinephric pseudocysts and International Renal Interest Society (IRIS) grade 3 acute kidney injury. Ultrasound-guided drainage of the cysts was performed initially; bilateral subtotal resection of the perinephric pseudocysts was later performed using laparoscopy as a more long-term solution. There was no regrowth or reformation of the perinephric pseudocysts 1 year after the procedure, and the cat remained in IRIS stage 2 chronic kidney disease 1 year postoperatively.
Relevance and novel information
Compared with traditional surgical approaches, laparoscopic resection of perinephric pseudocysts provides a less invasive approach. Bilateral perinephric pseudocyst in a pediatric feline patient (and associated treatment) has not previously been documented in the literature.
A 3-year-7-month-old female neutered domestic shorthair cat was presented for further investigation of acute-onset neurological abnormalities, including marked decreased mentation, ataxia and abnormal cranial nerve responses, with concurrent marked pyrexia (40ºC). Initial blood testing was non-specific with mild-to-moderate increases in alanine aminotransferase (ALT) (194 IU/l; reference interval [RI] 17–62 IU/l), aspartate aminotransferase (AST; 150 IU/l [RI 0–51 IU/l]) and total bilirubin (20 µmol/l; RI 0–11 µmol/l), and neutropenia (1.17 ×109/l; RI 2.5–12.5 ×109/l). Brain MRI and cerebrospinal fluid analysis were unremarkable and Toxoplasma serology was negative. Worsening of hepatic biochemical parameters (ALT 265 IU/l, AST 205 IU/l, total bilirubin 42.9 µmol/l) led to further investigations for liver disease, including ultrasound, fine-needle aspirate cytology, histology, fluorescent in situ hybridisation and culture of liver tissue and bile, resulting in a diagnosis of Yersinia pseudotuberculosis hepatitis. The cat was treated with a combination of potentiated amoxicillin (62.5 mg PO q12h), marbofloxacin (5mg PO q24h) and combined s-adenosyl methionine (SAMe)/silybin (90 mg PO q24h), and made a full recovery. Follow-up over 14 months identified a persistent mild increase in ALT, despite no apparent ongoing disease.
Relevance and novel information
Yersinia pseudotuberculosis hepatitis should be considered as a differential diagnosis in cats presenting with acute-onset neurological signs, and, when diagnosed, can be successfully treated with a combination of marbofloxacin, potentiated amoxicillin and SAMe/silybin. This is the first such case treated successfully with licensed veterinary antimicrobials and the first instance where Y pseudotuberculosis hepatitis has presented with primarily neurological clinical signs.
A 14-month-old male castrated domestic shorthair cat, which 2 months prior to presentation underwent hindlimb amputation following a road traffic accident, presented for investigation of four suspected generalised tonic–clonic seizures. Neurological examination was unremarkable. Routine blood work (haematology, biochemistry, ammonia, preprandial bile acids) was unremarkable. MRI of the brain identified marked symmetrical T2-weighted hyperintensities of the cerebellum and brainstem, mainly affecting the grey matter. Urine amino acid and mucopolysaccharide levels were unremarkable. Urine organic acids on two separate samples, 35 days apart, identified highly increased excretion of 2-hydroxyglutaric acid, indicative of 2-hydroxyglutaric aciduria. The cat was started on anticonvulsant therapy with phenobarbitone, which, at the point of writing, has improved seizure control, although the cat has not achieved seizure freedom.
Relevance and novel information
This case report describes the first reported case of a 2-hydroxyglutaric aciduria, an inherited neurometabolic disorder, as a cause for seizure-like episodes in a cat.
A 3-year-old male neutered domestic shorthair cat was presented for vomiting, inappetence and icterus. Biochemical results and ultrasonographic findings were consistent with cholestasis and possible biliary obstruction. A diagnosis of Candida albicans cholecystitis with associated hepatitis was made following cytologic examination and fungal culture. Progressive hyperbilirubinemia and hepatic encephalopathy were ultimately fatal.
Relevance and novel information
To our knowledge, this is the first report of biliary candidiasis diagnosed by cytologic examination of a cholecystocentesis sample in a domestic animal with no evidence of immunodeficiency. Additionally, this is the first reported case of fungal cholecystitis with associated white bile syndrome due to obstructive cholestasis, without an overt gall bladder mucocele.
An 8-year-old female spayed domestic shorthair cat was presented for evaluation of non-specific lethargy and pain. It was diagnosed with septic shock secondary to wounds on the dorsum and required treatment with multiple vasopressors for circulatory support. During the course of hospitalization, it was weaned from vasopressors but subsequently developed symmetric skin necrosis and sloughing of the paws on the right thoracic and right pelvic limbs leading to a presumptive diagnosis of suspected symmetrical peripheral gangrene (SPG).
Relevance and novel information
This report documents the first case of suspected SPG in a cat that received multiple vasopressors for treatment of septic shock. Early recognition, cessation of vasopressor therapy and surgical management are necessary for treatment of this condition.
A 2-year-old polytraumatized male cat was admitted to a teaching hospital for correction of a defective inguinal herniorrhaphy. Upon arrival, the cat showed signs of neuropathic pain, including allodynia and hyperalgesia. Analgesic therapy was initiated with methadone and metamizole; however, 24 h later, the signs of pain continued. Reparative surgery was performed, and a multimodal analgesic regimen was administered (methadone, ketamine, wound catheter and epidural anesthesia). Postoperatively, the cat showed signs of severe pain, assessed using the UNESP-Botucatu multidimensional composite pain scale. Rescue analgesia was initiated, which included methadone, bupivacaine (subcutaneous wound-diffusion catheter) and transversus abdominis plane block. Because the response was incomplete, co-adjuvant therapy (pregabalin and electroacupuncture) was then implemented. Fourteen days after admission, the patient was discharged with oral tramadol and pregabalin for at-home treatment.
Relevance and novel information
Neuropathic pain is caused by a primary lesion or dysfunction in the nervous system and is a well-described complication following trauma, surgical procedures such as hernia repair, and inadequate analgesia. The aims of this report are to: (1) describe a presentation of neuropathic pain to highlight the recognition of clinical signs such as allodynia and hyperalgesia in cats; and (2) describe treatment of multi-origin, severe, long-standing, ‘mixed’ pain (acute inflammatory with a neuropathic component). The patient was managed using multiple analgesic strategies (multimodal analgesia), including opioids, non-steroidal anti-inflammatory drugs, locoregional anesthesia, co-adjuvant drugs and non-pharmacological therapy (electroacupuncture).
This report describes a cat with chronic, progressive, non-painful, non-lateralizing multifocal neurologic clinical signs associated with feline infectious peritonitis (FIP). The cat initially presented as underweight, despite a good appetite, and a complete blood count showed non-regenerative anemia. Three months later the cat was returned having developed ataxia and paraparesis, which then progressed over 2 months to tetraparesis, tail plegia, urinary and fecal incontinence, and titubation. Histologic examination of the tissues with subsequent immunohistochemistry confirmed FIP-associated meningoencephalomyelitis following necropsy. Molecular analysis of the coronavirus spike protein within the tissues identified a specific, functionally relevant amino acid change (R793M), which was only identified in tissues associated with the central nervous system (ie, brain and spinal cord).
Relevance and novel information
This case report describes an early presentation of a cat with primarily neurologic FIP, with molecular characterization of the virus within various tissues.
An 11-year-old male neutered domestic shorthair cat presented with behavioural changes. Physical examination revealed bradycardia and a cranial abdominal mass. The cat was persistently hypoglycaemic (1.2 mmol/l; reference interval [RI] 3.5–5.5 mmol/l) with decreased fructosamine concentration suggesting chronic hypoglycaemia, and decreased insulin concentration excluding insulinoma. Alanine aminotransferase activity was markedly increased (1219.31 U/l; RI 15–60 U/l). On staging CT a large, multilobulated hepatic mass was identified, with no evidence of metastatic disease. After surgical removal serum glucose concentration and heart rate quickly returned to within the RIs. Histopathology was consistent with a solid-to-trabecular, well-differentiated, hepatocellular carcinoma. There was no recurrence of signs or mass during 8 months of follow-up, and the cat was still alive 20 months after surgery.
Relevance and novel information
Non-islet-cell tumour hypoglycaemia (NICTH) is a rare but life-threatening paraneoplastic syndrome. In humans, hepatocellular carcinoma is the most common epithelial tumour causing NICTH, but these are uncommon in cats, and associated paraneoplastic hypoglycaemia has not been reported. Possible mechanisms include aberrant secretion of big insulin growth factor 2; however, this could not be confirmed. NICTH should be considered in the differential diagnosis of cats with persistent hypoglycaemia.
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