Tuesday, September 12, 2017

3135. INTERN, EOSINOPHILIC GRANULOMA COMPLEX. A very old cat has eosinophilic granuloma complex ? Evidence needed.

Sep 12, 2017. At Toa Payoh Vets, big bleeding granuloma now seen.







Thin. Gums are cyanotic and possibly anaemic. No mouth or gum ulcerations.
Only a large granuloma, 1.5 cm x 2 cm x 1.0 cm below the chin.
No heart disease. No blood test, so not possible to assess liver and kidney functions.







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Owner had handphone pictures. Asked to be sent to me.











Need dental scaling. Cat has periodontal disease.
No blood test to screen health. Heart and lung and abdomen OK. .

biopsy of granuloma - advised
Fine Needle Aspiration. Impression smear of granuloma - advised. See lots of eosinophils in the smear or biopsy
Check for FIV/Feline Leukaemia needed.

Megestrol acetate given instead of corticosteroid in this case. 5 mg/day for 7 days and then alternate days. Cat's granuloma no longer bleeds so much, according to the owner when phoned 8 days after treatment. See images.









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WHAT IS EGC?  3 presentations






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OTHER SUSPECTED CASES OF EGC BELOW:














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Diagnosis



DIAGNOSIS is best confirmed by a biopsy or fine needle aspirate of the eosinophilic plaque but the owner wanted to save money and permitted FIV and blood tests only as she has other stray cats to pay for expenses. In this case, the blood test show a higher % of eosinophils at 6% and the clinical signs of oral ulcers, plaques and an old leg wound now healed) indicated a likelihood of the EGC.
Blood Test Results - significant findings
1. Glucose elevated 11.0 (normal 3.9 - 6.0) - "stressed induced hyperglycaemia" in the cat.
2. Liver enzymes ALT & AST elevated --- clindamycin >15-20 days and other antibiotics and powders could affect the liver.
3. Urea below normal.
4. Platelets low 146 (300-800). Large platelets present --- toxic products from medications affecting the platelets?  

RBC and WBC are normal.
Differential count - % and absolute numbers are:
N 64%   8.69
L 24%   3.19
M 6%    0.77
E 6%     0.81
B 0.3%  0.04

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3. RODENT ULCERS IN CATS (feline eosinophilic granulomatosis). Salivation and ulcers are signs.

Eosinophilic Granuloma Complex (EGC)

Three distinct but related clinical syndromes comprise the granuloma complex:

3.1 Eosinophilic (or rodent) Ulcer. This may occur on the skin or in the mouth but usually affects the upper lips. The lesions are well-demarcated ulcers.

3.2 Eosinophilic Plaque. These are raised, moist, red eroded or ulcerated areas with a well demarcated border. Pruritus is usually severe. Lesions usually occur on the underside of the cat (abdomen, brisket or inside the thighs).

3.3 Linear Granulomata. These can occur at most sites, especially behind the hind legs and within the mouth. They are well-demarcated lesions which are raised and yellow to
yellowish-pink in colour. They are often thin, hence the name *linear* granuloma.


Treatment:
1. Allergy to fleas, mites, parasites, environmental,
Steroid, ivomectin inj.

2. Allergy to dry cat food.
    If food allergy, hypo-allergenic canned food 6 weeks


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