FIP - what else could it be?

Re: FIP - what else could it be?

Anthony Dennison — Fri, 23 Nov 2012 12:18:47 GMT

I had a similar case at one of our branches, cat presented with uveitis/precipitate in eye and massively pyrexic, then it starts becoming paretic on it's hind limbs. advised most likely FIP but cant say for certain. Cat was from a shelter, was returned their and taken to their local vets. Older/more experienced vet took one look, said it was FIP and the cat was euthanased.

Re: FIP - what else could it be?

James Allsop — Fri, 23 Nov 2012 10:08:29 GMT

you could always do in-house cytology on the abdo fluid - presence of bacteria my change your differentials

Re: FIP - what else could it be?

Jo Cobbett — Fri, 23 Nov 2012 09:57:14 GMT

[quote user="Martin Atkinson"]

I don't wish to sound critical but if you worry about your diagnosis on this one you'll tear your heart out with more subtle cases.

[/quote]

I'm honestly not that worried about it, just curious (and thinking ahead to those more subtle cases where the flow chart might be more useful). Having said that, we have just had history requested from another vets for this cat as they want a second opinion. Happy to send the history across, as I'm sure we've worked this one up fully and given them the correct advice, I doubt the second opinion will be that different from ours.

Re: FIP - what else could it be?

Martin Atkinson — Fri, 23 Nov 2012 08:52:10 GMT

IME the one factor which is consistent to all cases of FIP is the hyperglobulinaemia, SPE can help to refine the analysis. With a FCoV titre this high it leaves little doubt, the ones which are tricky are the dry ones with a lowish titre but there is nearly always also a lymphopaenia accompanying the hyperproteinaemia. I don't wish to sound critical but if you worry about your diagnosis on this one you'll tear your heart out with more subtle cases. There can be no comeback one you for making a diagnosis of FIP in this case and even if by some unlikely chance it isn't you still made the right call on the information available - there isn't a vet in the country who wouldn't support you and as you say (I think this a good way of explaining the prognosis to owners in many cases) the cat is in deep shit whatever it is and the prognosis for any other differential is not much better.

Re: FIP - what else could it be?

Charlotte Marshall — Thu, 22 Nov 2012 23:00:46 GMT

I did a day course on feline infectious diseases a couple of years ago and the only real differential when you get to this level seemed to be lymphocytic cholangitis. My view was in that case why not give it preds. If it gets better it was lymphocytic cholangitis if it doesn't it was FIP.

Re: FIP - what else could it be?

Garfield — Thu, 22 Nov 2012 11:56:30 GMT

How old is the cat? Lymphocytic cholangitis?

Re: FIP - what else could it be?

Kate Richardson — Thu, 22 Nov 2012 11:55:52 GMT

I saw a case many years ago in Australia which had all the same markers and I was as certain as could be pre-mortem that it was FIP. This cat also had a palpable abdominal mass however which we suspected was a granuloma lesion. Ultrasound and fnas were not performed however as not available. The cat was really sick and surgery wasn't an option due to financial reasons and after much discussion with the owners we elected to euthanase the cat. The owners permitted me to do a post mortem (at no cost to themselves) and we found a mass lesion with bowel running through it which we sent for histopath to hopefully confirm a granuloma lesion and the diagnosis of FIP. The histopath came back as a chronic deep bacterial infection, poss FB cause (although no FB seen). Unless the histopath was wrong, this was one that was potentially treatable, but due to circumstances I don't think the wrong decision was made.

It would be great if we had a definitive diagnostic test to confirm FIP pre mortem and in your case I also think FIP is 99.9% certainty, but their is always that small amount of doubt I guess. And I say this having had one of my own young cats develop FIP a year ago (confirmed post mortem) but all the way there was that small amount of doubt in my own mind even with the valued and much appreciated advice and support from the feline team at Langford.

I don't know if Langford are still requiring tissue samples from FIP cases, but if your owners are willing to help with their research, it may be worth contacting them (Contact Severine Tasker), but they are doing a lot of research into developing a diagnostic test. They require samples to be taken immediately after death and can come and collect the samples for you depending on location or will provide a full kit and instructions on what they need. I did this with my little boy and it was really hard, but I felt that at least some good may come from his sad fate.

Re: FIP - what else could it be?

Jo Cobbett — Thu, 22 Nov 2012 11:20:27 GMT

[quote user="Martin Atkinson"]

How old is the cat, does the fluid clot? This is as nailed on a case as you'll ever see unless its a 15 year old indoor cat with a heart murmur,abdominal tumours and liver disease and then its still probably FIP with a FCoV titre that high. Why do you need a flow chart?

[/quote]

I'm not in any doubt about this case. It's just frustrating to have to tell the owner "I can't say categorically that this is FIP", particularly when the prognosis for FIP is so poor. (Although, as mentioned earlier in this thread, the prognosis for any possible diagnosis with these signs will be more or less the same).

I was just wondering it anyone had seen a case like this that wasn't FIP, and if so, what was it?

Re: FIP - what else could it be?

Martin Atkinson — Thu, 22 Nov 2012 08:53:41 GMT

Re: FIP - what else could it be?

Rob Loxley — Wed, 21 Nov 2012 23:14:05 GMT

The ABCD guidelines are also worth a read

Re: FIP - what else could it be?

Catherine Coen — Wed, 21 Nov 2012 19:16:33 GMT

There's a flow chart and lots of info on Diane Addie's website. Here's the address: http://www.dr-addie.com/downloads/FIPdiagnosisflowchart.pdf

Re: FIP - what else could it be?

Catherine Coen — Wed, 21 Nov 2012 19:16:33 GMT

There's a flow chart and lots of info on Diane Addie's website. Here's the address: http://www.dr-addie.com/downloads/FIPdiagnosisflowchart.pdf

Re: FIP - what else could it be?

Rachael Winder — Wed, 21 Nov 2012 18:20:03 GMT

I think you can do immunohistochemistry for intracellular FCoV on fluids or biopsy specimens, which is definitive if positive. And an AGP at that level with a high pretest probability of FIP is fairly specific.

Re: FIP - what else could it be?

Emily Rainbow — Wed, 21 Nov 2012 17:19:42 GMT

They're doing a lot of work here in Bristol on a FIP PCR, I'm afraid I don't know the details, but they have had some success. Might be worth getting in contact with Severine Tasker.

Re: FIP - what else could it be?

Hannah Wynne Richards — Wed, 21 Nov 2012 16:52:35 GMT

Is the fluid sticky? One of those symptoms might give me pause for thought...............but add them all up!!!!!!!!!!!!!!!

Wynne

Re: FIP - what else could it be?

Mark Holmes — Wed, 21 Nov 2012 16:44:50 GMT

If it looks like a duck and quacks like a duck.....

The important question is if its NOT FIP do the alternative differentials carry a better prognosis given the level of presenting disease. I assume the cat is presenting with weight loss, ascites and has a poor appetite and demeanor? It sounds like FIP to me but I would be of the opinion that regardless of what is producing the symptoms the outcome will be the same and hence would not be overly worried about the small chance of a misdiagnosis.