Eosinophilic granuloma in cats

Re: Eosinophilic granuloma in cats

Siobhan Westbrook — Wed, 21 Dec 2011 13:40:12 GMT

I agree with Kate. I good solid course of pred at the right dose is worth trying surely. Depending on how satisfied you were that the original biopsies were representative.

Also there's a large area (!) to take impression smears from to see if neutrophils and bacteria are present; if not, perhaps you can risk leaving out the antibiotics?

Re: Eosinophilic granuloma in cats

Utlendigur — Tue, 20 Dec 2011 19:41:26 GMT

[quote user="Kate Richardson"]as they be able to suggest other suitable corticosteroids and doses (methylprednisolone, dexamethasone, betamethasone, budesonide) [/quote]

I thought budesonide was virtually all broken down in its first pass through the liver, so only really active in the gut?

I'd also be a bit suspicious of mammary neoplasia. Was it a single biopsy or several? From centre of lesion or periphery? Maybe more than one condition. Saying that, I saw a cat last week with history of miliary eczema, FAD, previous eosinophilic granulomas that had developed lesions very similar to your cat, bilaterally on the elbows plus one on flank. They usually seem to need long courses of corticosteroids and cats seem to tolerate higher doses than dogs aswell.

Re: Eosinophilic granuloma in cats

Kate Richardson — Tue, 20 Dec 2011 19:33:29 GMT

[quote user="Richard Fox"]

I agree Kate but if its refractory to treatment then a repeat biopsy or cytology as I suggested above maybe pertinent - that's all I have seen EGC lesions look as big as that esp with self trauma before.

[/quote]

I don't disagree, I just don't think this cat has had a high enough dose of pred to say it is refractory yet

Re: Eosinophilic granuloma in cats

Laurence Webb — Tue, 20 Dec 2011 19:25:13 GMT

[quote user="Evelyn Barbour-Hill"]

Dermatological surgery. Cut out the bad stuff and sew up the good stuff.

[/quote]

"Call a dermatologist. If it's wet, keep it dry. If it's dry, keep it wet. If it's not supposed to be there, cut it off. I never could remember all that"

Doctor Gregory House MD

Re: Eosinophilic granuloma in cats

Evelyn Barbour-Hill — Tue, 20 Dec 2011 15:37:09 GMT

Dermatological surgery. Cut out the bad stuff and sew up the good stuff.

That's no help with the "rodent ulcers" though.

Re: Eosinophilic granuloma in cats

Anthony Todd — Tue, 20 Dec 2011 14:44:43 GMT

[quote user="Stephen Courtney"]if it is neoplasia[/quote]

Why not excise it whilst you're taking the biopsy? Should be easy to get it all, and plenty of spare skin, as I have said.

Why pussy-foot around [sorry, couldn't resist]

I just can't believe it's just an ESG. [??EoSinophilic Granuloma??] It just looks all wrong?? Looks like cancer to me.

Re: Eosinophilic granuloma in cats

Stephen Courtney — Tue, 20 Dec 2011 14:15:50 GMT

I've used atopica at 25mg daily on several cats for refractory skin conditions with good results. Not been worried about the lack of a license at all as its useage in cats is well established. i agree the liquid formulation will be easier to use.

I agree with repeat biopsies,but given the poor prognosis if it is neoplasia, if the client isn't keen just crank on with treatment based on the first biopsy. you could also ask the pathologist to review the slide, perhaps make a fresh section to examine?

when faced with these i tend to give an injection of depomedrone every two weeks until they resolve ( usually do) or i get scared. My standard dose is 0.5ml per cat per two weeks. I cover with antibiotics ( hesitate to say convenia but it is my favourite, at least I don't mix them in the same syringe...!)

I've yet to find a flea on a cat with these lesions,I guess they get chased away pretty fast! but you need good flea control - and make sure that includes all dogs and cats in the home - and the really raw sore ones often benefit from bathing with cold strong black tea. Old fashioned i know but it is soothing and the tannins help dry the lesions up. just steep a teabag in boiling water, perhaps in a quarter mug, and use the cold infusion to dampen the cotton wool which you then use to dab the raw areas. clients love doing this too, keeps them involved i guess - plus it's free!

Re: Eosinophilic granuloma in cats

James Allsop — Tue, 20 Dec 2011 14:12:14 GMT

About 6 months ago I had an EGC case that was responding to depo but then became diabetic so had to stop depo. once on insulin and more stable managed to get some response to convenia and cortavance but not great so looked into using Atopica off licence. It was recommended to check the cat for FIV/FeLV and Toxo prior to starting atopica although the fact that the cat was diabetic was also a contraindication.

Re: Eosinophilic granuloma in cats

Richard Fox — Tue, 20 Dec 2011 13:59:28 GMT

Re: Eosinophilic granuloma in cats

Kate Richardson — Tue, 20 Dec 2011 13:07:22 GMT

Just because something looks like cancer doesn't mean it is. Eosinophilic ulceration CAN look just like this, but if any doubt, then I agree, repeat the biopsy or speak to your lab, but if you are happy with your original biopsy depth (did you take multiple samples?) then I would pursue your treatment. Quoting from BSAVA formulary, immunosuppressive doses of prednisolone in cats are 2.2-6.6mg/kg BID, tapering once you have a response. So if you are happy with your diagnosis, I would consider increasing your pred dose, as you have only used 1mg/kg roughly so far. I would prob increase to 10mg bid then increase further if necessary. I would keep it on the effective dose until you have remission and then taper accordingly. If funds allow, then consider cyclosporin. And I would certainly speak to a dermatologist as well, as they be able to suggest other suitable corticosteroids and doses (methylprednisolone, dexamethasone, betamethasone, budesonide) if pred just isn't effective in this case. Also ensure strict and effective parasite control measures and consider a hypoallergenic diet.

Re: Eosinophilic granuloma in cats

Anthony Todd — Tue, 20 Dec 2011 11:43:25 GMT

[quote user="Dagmar Steele"]this looks much more like a mammary carcinoma to me [/quote]

Yeah, come to think of the few I remember, it does to me too. Be nice to have seen it earlier.........

I wonder what the rationale behind long acting depomed AND pred is??

And how long was the cat which fell into diabetes on Ovarid for?? Some of the "hormonal dermatitis" cats were on 5mg weekly for months if not years.

I remember a well-known west London vet grabbing some Ovarid instead of Paracetamol for his headache.

Said he still had the headache but stopped worrying about it.......

Re: Eosinophilic granuloma in cats

Amanda Nicholls — Tue, 20 Dec 2011 11:35:40 GMT

[quote user="Bob Russell"]

[quote user="amanda nicholls"]

[quote user="Busybee"]

Atopica? (off licence obviously!)

[/quote]

not for much longer and would be my choice

[/quote]

I understand Atopica will be available in liquid form,. licensed for cats in January 2012! Apparently for inflammatory skin conditions rather than just atopy. We all have at least one problem cat case so will be interesting to see how it goes!

[/quote]I am so happy it is going to be available in the liquid form, I am pleased with the results I have had using the capsules but they are big and most owners do struggle administering them!

Re: Eosinophilic granuloma in cats

Judith Joyce — Tue, 20 Dec 2011 11:02:23 GMT

I am with those suggesting that the diagnosis should be carefully reviewed before chasing ever more exotic treatment options. The pattern reported by the pathologist could well be a consequence of the self-trauma and not its cause.

Malcolm N

Re: Eosinophilic granuloma in cats

Bob Russell — Tue, 20 Dec 2011 09:57:30 GMT

[quote user="amanda nicholls"]

[quote user="Busybee"]

Atopica? (off licence obviously!)

[/quote]

not for much longer and would be my choice

[/quote]

Re: Eosinophilic granuloma in cats

Gerry Henry — Tue, 20 Dec 2011 09:44:19 GMT

I would agree with Richard, rebiopsy with sampling from multiple sites; collar for 6 wks plus intralesional Depomed usually works for me - plus personally supervised flea control, plus exclusion diet; personally I wouldn't ever use Ovarid again having pushed at least one cat into a diabetic state.

Re: Eosinophilic granuloma in cats

Dagmar Steele — Tue, 20 Dec 2011 09:42:31 GMT

only judging from the photo and personal experience this looks much more like a mammary carcinoma to me than anything. I would expect a rodent ulcer or eosinophilic lesion to react to some of the meds you've used. Personally, I would not be very optimistic but cut it out....

Re: Eosinophilic granuloma in cats

Richard Fox — Tue, 20 Dec 2011 09:32:53 GMT

If there is absolutely no response then I would repeat biopsy just in case you have 2 things going on i.e. mammary neoplasia or similar - or excoriate and do impression smears (after damping the blood off)/aspirates looking for eosinophils - just to make sure ? (deep sampling)

I presume its Female?

Re: Eosinophilic granuloma in cats

Richard Carter — Tue, 20 Dec 2011 09:22:35 GMT

If you are convinced results are correct as agree doesn't look very typical, intralesional depo-med and bid preds 5mg 2 - 3 weeks with covering abs, otherwise excise and keep on preds with extended suture period would be my approach.

Re: Eosinophilic granuloma in cats

Noweia — Mon, 19 Dec 2011 23:33:49 GMT

Confirmed by biopsy and histo of a large chunk.

Cannot remember weight of cat or antibiotic doses as I don't have the records here and I've only seen it once, but I think it's about 4kg.

Thank you everyone for your replies so far!

Re: Eosinophilic granuloma in cats

Anthony Todd — Mon, 19 Dec 2011 23:24:49 GMT

[quote user="Andrew Kent"]Biopsy?[/quote]

Doesn't look like a typical eosinophilic granuloma to me, I must say, and looks as if it is being constantly got at by the cat??

Any chance of a dressing or an elizabethan collar?? Should be able to remove it; plenty of skin spare, but self-trauma will create another one if the area isn't protected. I was always reluctant to operate but others did and they were successful too, so I was wrong.

I believe some of these were just a type of flea allergy [as was so-called linear granuloma on the back legs] and flea control seemed important in preventing recurrence or further FAD.

I always used depomed sub cut, or rather sub granuloma, rather than by usual S/C jab, and around 20mg repeating as soon as lesion began to regress.. Pred is a waste of time in these IMHO.

"Rodent ulcers" always responded to Ovarid with or without depomed eventually.......

It may be that the rodent ulcers are being exacerbated by the licking of the eosinophilic granuloma?

I'm not sure that I had any success with antibiotics in this complex ever.

Re: Eosinophilic granuloma in cats

Andrew Kent — Mon, 19 Dec 2011 23:05:09 GMT

In what way was this confirmed by lab? Biopsy? What antibiotics have been used and at what dose? What weight is the cat? Eosinophilic granulomas take fairly prolonged prednisolone courses so 7 days may not have been sufficient, as others have said cyclosporine could be a good alternative.

Re: Eosinophilic granuloma in cats

Amanda Nicholls — Mon, 19 Dec 2011 22:30:51 GMT

[quote user="Busybee"]

Atopica? (off licence obviously!)

[/quote]

not for much longer and would be my choice

Re: Eosinophilic granuloma in cats

Evelyn Barbour-Hill — Mon, 19 Dec 2011 20:57:34 GMT

If in doubt, cut it out............ But I'm just a surgeon, me.

Sorry. Right. By "rodent ulcers" do you mean those chronic lesions on the upper lip? (Current fashion demands that one frowns on calling them rodent ulcers) . If they do not respond to a prolonged course of a suitable corticosteroid and a suitable antibiotic, one should consider the other factor involved which is the constant trauma from the tongue. I have had success constructing an acrylic plate which is fixed to the teeth and protects the lips from the tongue, but this was rather a last resort and I may have been lucky.

Re: Eosinophilic granuloma in cats

Noweia — Mon, 19 Dec 2011 20:48:53 GMT

[quote user="Kate Richardson"]

What corticosteroid did you use and what dose?

[/quote]

So far it's had:

Pred 5mg BID 7d, SID 3d. (along with antibiotic cover)

Metacam

Ovarid 5mg EOD 10d, once a week for 4 weeks

Depomedrone injection (again with antibiotic cover)

None of which have worked. Biding my time deciding what to do with it I've injected Convenia and started it on Norbet 0.5 SID for 14 days.

Re: Eosinophilic granuloma in cats

Kate Richardson — Mon, 19 Dec 2011 20:40:12 GMT

What corticosteroid did you use and what dose?