Cat with hepatitis, now hypereosinophilic - time for the 'roids?

Re: Cat with hepatitis, now hypereosinophilic - time for the 'roids?

Andrew Kent — Tue, 02 Jun 2015 14:44:42 GMT

Hi Martin,

Was this a liver aspirate or biopsy? If an aspirate then I am not sure that we can always draw much of a conclusion from them (other than excluding things like lymphoma).

If biopsy - could you post the actual pathological description rather than conclusion?

Andy

Re: Cat with hepatitis, now hypereosinophilic - time for the 'roids?

Martin Atkinson — Tue, 02 Jun 2015 14:24:53 GMT

[quote user="Rory Bell"]Any chance of seeing the biopsy report? [/quote] Sorry for delay in replying I've only just spotted your post. ''Cytological analysis of the liver and spleen were suggestive of a moderate vacuolar hepatopathy. There is evidence for lipid accumulation in the liver and given the clinical history this is suggestive of hepatic lipidosis. No obvious aetiology for this is seen on these preparations it may be primary or secondary to many systemic conditions including cholangitis. The most likely differential diagnosis would be neutrophilic cholangitis although a lymphocytic cholangitis cannot be excluded'. The clinical signs are most consistent with a chronic form which can also lead to secondary inflammation of the pancreas and small intestine'.

[quote user="Rory Bell"]Did you culture anything (bile or liver tissue)?[/quote]'Culture of liver aspirates and bile showed no micro-organisms cultured after 48 hrs (culture to continue for 7 days' (that has now expired).

[quote user="Rory Bell"]How bad is that dermatitis?[/quote]One little patch which if wasn't over 2 weeks after the clipping for ultrasound I would have though was clipper rash.

[quote user="Rory Bell"]I am in awe of your ability to persuade an owner to administer 6 different meds to a cat that hates being tableted[/quote]Not sure on compliance, we're trying Samylin granules now as it won't take tablets.

Re: Cat with hepatitis, now hypereosinophilic - time for the 'roids?

Rory Bell — Fri, 29 May 2015 20:57:58 GMT

Any chance of seeing the biopsy report? Curious as to the distribution of inflammatory cells throughout the parenchyma and also how many eosinophils were present. Did you culture anything (bile or liver tissue)? If the cat is improving then perhaps it might be worthwhile confirming the eosinophil count before changing a therapeutic regime that seems to be effective... (I am in awe of your ability to persuade an owner to administer 6 different meds to a cat that hates being tableted by the way, even if it is hit and miss!)

Cats are good at mounting a hypereosinophilia secondary to inflammation, might be that the dermatitis is causing the hypereosinophilia and it's not connected to the hepatopathy? How bad is that dermatitis?

I'm not saying that steroids are wrong in this instance.....maybe I'm being over-cautious.

cheers

Re: Cat with hepatitis, now hypereosinophilic - time for the 'roids?

Anthony Todd — Fri, 29 May 2015 20:57:11 GMT

[quote user="Martin Atkinson"]Cat was brought in because of losing weight and polydypsia, appetite variable.[/quote]

Even a dinovet would have done bloods.

[quote user="Martin Atkinson"]X-ray showed a radiopaque lesion about 5mm diameter[/quote]

Probably a dinovet would have done an exlap.

Ex lap NAD, eosins 41%

Most dinovets would reach for the 'roids

Can check with any still compos if you want....

Re: Cat with hepatitis, now hypereosinophilic - time for the 'roids?

Kate Richardson — Fri, 29 May 2015 20:00:13 GMT

No, I think pred is one of the best drugs ever when used appropriately. Dinovets would have given it pred on day 1 and forget the bloods, scan and what- biopsies???!!!! :-)

Re: Cat with hepatitis, now hypereosinophilic - time for the 'roids?

Martin Atkinson — Fri, 29 May 2015 19:32:55 GMT

[quote user="Kate Richardson"]So yes, I would get it onto pred[/quote]That doesn't mean we're turning into dinovets does it Kate?

Re: Cat with hepatitis, now hypereosinophilic - time for the 'roids?

Kate Richardson — Fri, 29 May 2015 19:01:40 GMT

Yes, but I would also consider four quadrant antibiotic therapy (clav/marboflox and metronidazole) in these cases. But lymphocytic inflammation suggests pred deficiency. Only concern with the eosinophilia is underlying neoplasia but biopsies don't suggest this and lymphoma generally likes to be found.

So yes, I would get it onto pred