Lymphoplasmocytic cholangiohepatitis and suppurative pancreatitis cat treatment

RE: Lymphoplasmocytic cholangiohepatitis and suppurative pancreatitis cat treatment

Andrew Kent — Thu, 04 Mar 2021 21:17:36 GMT

Sorry to hear that Jo - a sad outcome indeed!

Andy

RE: Lymphoplasmocytic cholangiohepatitis and suppurative pancreatitis cat treatment

joanne mcallister — Thu, 04 Mar 2021 11:03:58 GMT

Hi Andy,

Just to give you an update on this little cat. She was clinically well enough to be rehomed and we advised her to remain on destolit. Unfortunately she developed a presumed relapse of cholangiohepatitis (was seen at another practice) and the new owners elected to have her euthanased.

Thank you for your advice. Obviously a sad outcome but at least she had a few weeks in a home and was very loved,

RE: Lymphoplasmocytic cholangiohepatitis and suppurative pancreatitis cat treatment

Andrew Kent — Mon, 25 Jan 2021 21:23:48 GMT

I generally continue the UDCA at least until the blood work is (hopefully) normal. You may be able to stop after that if everything else is going well but equally its a well tolerated drug so doesn't worry me to continue long-term if needed.

Andy

RE: Lymphoplasmocytic cholangiohepatitis and suppurative pancreatitis cat treatment

joanne mcallister — Mon, 25 Jan 2021 11:46:47 GMT

I have just repeated bloods on this cat and alt is now 267, alkp 161 and chol 8.3. Everything else WNL. She is clinically well and started to gain some weight

She has been on z/d and ursodeoxycholic acid only for the past 2 weeks

I plan to continue with z/d once we rehome her but do you think we should stop the ursodeoxycholic acid at some point?

RE: Lymphoplasmocytic cholangiohepatitis and suppurative pancreatitis cat treatment

Andrew Kent — Mon, 11 Jan 2021 22:17:30 GMT

The metronidazole thing is an interesting one - whilst lots of people talk of this there is essentially no evidence supporting an anti-inflammatory role so I definitely wouldn’t use it for that purpose. It’s one of those antibiotics I now rarely use as the spectrum typically overlaps with other antibiotics so no real indication.

Andy

RE: Lymphoplasmocytic cholangiohepatitis and suppurative pancreatitis cat treatment

joanne mcallister — Mon, 11 Jan 2021 08:56:33 GMT

Thanks Andrew. I added the metronidazole as I had read the anti-inflammatory action would help but will stop this now

RE: Lymphoplasmocytic cholangiohepatitis and suppurative pancreatitis cat treatment

Andrew Kent — Sun, 10 Jan 2021 09:24:01 GMT

Thanks for the update. I guess the ALT is improved just not as much as we might like.

i would consider tapering the steroid, stopping the metronidazole (I don’t see this adds anything at this stage), continuing the fluoroquinolone plus ursodeoxycholic acid for the moment and starting the strict diet trial. See what the bloods are doing in a few weeks and consider further sampling if not improving.

Andy

RE: Lymphoplasmocytic cholangiohepatitis and suppurative pancreatitis cat treatment

joanne mcallister — Fri, 08 Jan 2021 15:28:26 GMT

Last 2 biochem results above. I'm afraid there is no haematology as samples have to be taken under sedation (very difficult cat to handle!)

RE: Lymphoplasmocytic cholangiohepatitis and suppurative pancreatitis cat treatment

joanne mcallister — Fri, 08 Jan 2021 13:56:31 GMT

Many thanks for your advice Andrew.

We haven't undertaken a diet trial but will do so. Unfortunately I don't feel confident doing an ultrasound-guided bile aspirate.

Below are histopath and bile culture results. I will post the recent blood work shortly.

Feline
Histopathology
Histology Report 582011 Nina JSPCA
Specimen: Two sections from the liver and one section from the pancreas.
Description: Liver: These sections are comprised of wedges of liver tissue. The parenchyma is comprised of cords and plates of mature well differentiated hepatocytes with central veins and portal tracts in normal architectural relationship. Throughout the section in periportal distribution there are moderate to large numbers of infiltrating small lymphocytes with admixed plasma cells and macrophages. Rare neutrophils and eosinophils are also present. There is congestion of the sinusoids and central veins. There are increased numbers of Ito cells and small numbers of hepatocytes contain lipofuscin. There are scattered Kupffer cells which contain haemosiderin granules, scattered lipogranulomas and there is often bile plugging of the canaliculi.
Pancreas: This section is comprised of lobules of exocrine pancreatic tissue separated by scant stroma. There are multifocal periductular infiltrates of lymphocytes and plasma cells present within the lobules with diffuse interstitial infiltrates of neutrophils.
Diagnosis: Liver: Moderate lymphoplasmacytic cholangiohepatitis. Pancreas: Chronic suppurative pancreatitis.
Comment: In these sections there is a moderate grade lymphoplasmacytic cholangiohepatitis with concurrent pancreatitis. Triaditis is the medical term used to describe the combination of 1) cholangiohepatitis, 2) pancreatitis, and 3) inflammatory bowel disease (IBD). It is not uncommon for all three organs systems to be involved and in a recent study, 83% of cats with cholangiohepatitis were also found to have inflammation of the duodenum and/or jejunum and 50% were diagnosed with lesions on their pancreas. Long term management is dependent upon controlling the inflammation in all three organ systems but with appropriate therapy a favourable prognosis is possible.

MICROBIOLOGY

*Site: BILE :

Aerobic Culture

*Isolate 1

Profuse growth : Moraxella sp

Antibiotic Result MIC Sensitivity Range

--------------------- ---------- ------ ----------------

*Ampicillin SENSITIVE

*Amoxicillin-Clavulan SENSITIVE

ic acid

*Cephalexin SENSITIVE

*Enrofloxacin SENSITIVE

*Marbofloxacin SENSITIVE

*Potentiated SENSITIVE

sulphonamides

*Gentamicin SENSITIVE

*Cefovecin SENSITIVE

Organism identified by MALDI-TOF

MIC testing was unable to be performed on this isolate;

therefore MIC results and reference ranges are not

available. A susceptibility profile based on disk diffusion

testing has been reported.

Note: Generic antibiotics quoted. The choice of antibiotic

and knowledge of any contraindications is the Veterinary

Surgeons responsibility.

*Isolate 2

Scanty growth : Pseudomonas spp

Antibiotic Result MIC Sensitivity Range

--------------------- ---------- ------ ----------------

*Ampicillin Resistant >=32 2 sssiR 32

*Amoxicillin-Clavulan SENSITIVE 8 2 ssSir 32

ic acid

*Ceftiofur Resistant >=8 1 ssiR 8

*Gentamicin SENSITIVE <=1 1 Sssir 16

*Enrofloxacin SENSITIVE <=0.12 0.12 Sssiir 4

*Marbofloxacin SENSITIVE <=0.5 0.5 Ssir 4

*Doxycycline SENSITIVE <=0.5 0.5 Ssssir 16

*Tetracycline SENSITIVE <=1 1 Sssir 16

*Potentiated SENSITIVE <=20 20 Ssrrr 320

sulphonamides

*Chlortetracycline SENSITIVE

Organism identified by MALDI-TOF

RE: Lymphoplasmocytic cholangiohepatitis and suppurative pancreatitis cat treatment

Andrew Kent — Tue, 05 Jan 2021 21:18:35 GMT

Hi Joanne,

Is it possible to post the histopath and culture results as well as recent blood work? I would generally expect to see a significant improvement over 5 weeks so its a concern that the bloods remain quite abnormal.

Ideally I would repeat an ultrasound and re-culture bile as we may have resistance, for example. I am not a huge fan of treating these cats with steroid and antibiotics because they are, in essence, doing an opposite thing. If we think there is a significant infectious process then I treat that with antibiotics and see where you are. I then consider a steroid if the situation seems sterile but inflammation is ongoing.

I would also look at a decent diet trial if not already done?

Andy