2922. An eosinophilic cat has a "lungworm"?

Has the chronic coughing cat a lungworm?

This is a strange case. The much beloved old Himalayan cat has chronic coughing for the past 6 months. Yet the heart and lung sounds were normal when examined by Vet 1 earlier and myself on Jan 18, 2016. I could hear rapid breathing which could be due to this cat being unhappy at the vet.
The cat had good appetite but now had a sore throat owing to daily coughing nowadays. 

MEDICAL HISTORY.
Oct 2015. Went to Vet 1.  Occasional cough. Cough medicine did not banish the coughing.
Dec 2015. Went to Vet 1.  Coughing more often. Vet 1 wrapped cat around towel to examine the cat in a room away from the owner. Vet 1 prescribed antibiotics and steroids but the owner did not give them to the cat as there was no definitive diagnosis. Vet 1 did advise X-rays.Vet 1 noted that the heart and lungs sounds were normal.

On Jan 18, 2016, a mother and young adult daughter brought the cat to consult me. I confirmed the heart and lung sounds were normal. There was a rapid breathing rate which I attributed to the cat being unhappy with examination by any vet as he tried to claw me now and then. He did not like his head area touched. I palpated his enlarged left submandibular lymph node when the owners were distracting him, but he would not permit opening of his mouth. Was there a tumour in his painful throat?

"X-rays of the throat and lungs are needed to check for tumours or other abnormalities," I advised as simply giving antibiotics would not be useful in chronic coughing. "A blood test is needed to check for blood-borne infection and diseases of the liver and kidneys." 

The owners agreed and the results are as follows:


X-RAYS

The cat was stressed when isoflurane gas was given via the carrier and bag. As an alternative, he was given a lowest dosage of IM injection - xylazine 0.3 + ketamine 0.2 ml IM to enable a thorough physical examination of the mouth, throat and abdomen.

Reversin 0.15 Im woke up the cat in less than 15 minutes.


 
 

 

BLOOD TEST
Leucocytois with neutrophilia and thrombocytopenia suggest a septicaemia on Jan 18, 2016.
Eosinophilia suggests allergy, parasitic or tumour condition. 
No liver or kidney disorders.

COMMENTS
Close up of the X-ray appeared to show a donut-shaped object looking like a lung worm swallowed inside the left lower lung. This would account for the eosinophilia. Tumours would also cause eosinophilia. Eosinophilic granuloma is a possibility although the lesions manifest in the mouth and skin usually.

The X-ray shows a full stomach, suggesting that the cat has a good appetite. The throat was very painful due to daily coughing. Antibiotics and anti-inflammatory medication was given. Review in 10 days. May need deworming (Panacur, ivomectin or Revolution).

PHYSICAL EXAMINATION UNDER SEDATION
Tonsils are enlarged. The owner said they had been enlarged for some time. No tartar or calculus in all snow white teeth as if they were brushed daily. 

 

CONCLUSION

Follow up by tel on Jan 19, 2016. 
"The cat eats and is more active," the young lady said. "Less coughing."
"If the lung lesion is not a tumour or lungworm, we will see complete recovery in a month," I said. 

Chronic coughing of 6 months' duration and old age suggests a high probability of a pulmonary tumour.  A review is needed in 2-4 weeks' time by telephone.