Page 10 - Clinical Connections - Spring 2023
P. 10

RVC RESEARCH    STUDY    VETERINARY SERVICES       RVC.AC.UK
         Internal Medicine

        COMPLEX FELINE INFECTIOUS PERITONITIS
        CASE


        Jodie Green, Internal Medicine Resident

               illie, a six-month female neutered                                Millie was discharged after ten days in
               domestic short hair, was presented                               hospital  to  complete  her  12-week  course
        M to RVC Small Animal Referrals due                                     of  GS-441524  (a  nucleoside  analogue
        to poor weight gain and a one-week history                              antiviral drug) at home. Millie was the 63rd
        of progressive lethargy and hyporexia.                                  cat with FIP to be treated at the RVC with a
          On presentation to our Emergency Service,                             combination of remdesivir and GS-441524.
        Millie was found to be icteric and pyrexic.                             Over  80%  of  cats  undergoing  treatment
        She was severely hypoglycaemic and                                      for FIP at the RVC have survived to make
        suffered a hypoglycaemic seizure, requiring                             a full recovery but Millie is the first cat with
        aggressive glucose supplementation. Millie                              both  hypoglycaemia  and  anaemia  severe
        was also severely anaemic, with a PCV of                                enough to require a blood transfusion to
        12%, and required a feline packed red blood                             survive.
        cell transfusion.                                                        Millie was discharged from the Queen
          Biochemistry             identified                                   Mother Hospital for  Animals (QMHA) in
        hyperbilirubinaemia,  hyperglobulinaemia                                early  December  last  year  and  remains  in
        and  hypoalbuminaemia,  with  an  albumin/                              clinical remission from FIP.
        globulin  ratio  of  0.36.  Millie  was  found  to                       Millie’s  successful  outcome  would  not
        have  a  protein-rich  abdominal  effusion,                             have been possible without the collaboration
        with   pyogranulomatous   inflammation.                                 of specialists, residents and nurses from our
        Haematologic  examination  also  identified                             Emergency and Critical Care team, Internal
        a severe non-regenerative anaemia with                                  Medicine team and  Transfusion Medicine
        evidence of erythrophages and microscopic                               teams.
        agglutination  suggestive  of  immune-
        mediated destruction.                                                   Evolving FIP treatment at the RVC
          Millie’s clinical picture and investigations                          Feline infectious peritonitis is a rare disease
        were most suspicious for a diagnosis of                                 caused by a mutated enteric coronavirus.
        effusive  feline  infectious  peritonitis  (FIP).   Millie was in hospital for ten days   Historically the disease was considered
        However,  Millie’s  picture  was  complicated                           almost always fatal, due to a lack of
        by her severe hypoglycaemia and anaemia.   Due to her severe anaemia, Millie’s   efficacious treatment.
        Many factors were likely contributing to   condition initially deteriorated, and she   However over the past few years, a small
        Millie’s anaemia, including consumption and   required  a  xenotransfusion  and  a  further   number of studies showed that the antiviral
        immune-mediated destruction as a result of   feline  packed  red  blood  cell  transfusion   drug remdesivir and its parent nucleoside
        her FIP.                            in order to  stabilise  her. Millie continued   GS-441524 could be the key to successfully
          Millie required an extensive stay in   to show clinical improvements following   treating FIP in cats. Remdesivir became
        our ICU for supportive care, intravenous   treatment for her FIP  and,  after six days,   licensed  to  treat  COVID-19  infections  in
        glucose and potassium supplementation,   her anaemia had become regenerative and   human patients early in the pandemic and
        and was started on intravenous remdesivir   her red blood cell concentration was able to   the drug then became widely accessible in
        (20m/kg) for treatment of her FIP.   recover.                           the UK to treat FIP.




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                                                                                      For small animal referrals, please call:
                                                                                     01707 666399
                                                                                      Email:
                                                                                     qmhreception@rvc.ac.uk

        10   Spring 2023
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