Hi All,
Dr. Hylands discussed eosinophilic cystitis at the Sonopath Clean Up lab in December, but I can’t recall exactly what his thoughts were.
Hi All,
Dr. Hylands discussed eosinophilic cystitis at the Sonopath Clean Up lab in December, but I can’t recall exactly what his thoughts were.
- 6 year old MN Maine Coon cat, blocked Sunday this week. I saw him in GP but sent him to the EC for unblocking (as it was sunday and we were closing in 1 hour).
- EC unblocked, placed Ucath, did UA (no overt infection but did not culture), started on prazosin and gabapentin.
- Cath was pulled in 48 hours (? – sorry my history is a bit fuzzy) and cat reblocked same night.
- Cath has been pulled then replaced twice due to re-blocking.
- No antiinflammatories or skeletal muscle relaxers were given.
- Owner is a friend so I just scanned him today. He has a hyperechoic plaque type lesion in the gravity dependent part of the bladder but I couldn’t “unstick” it from the wall. Didn’t uptake doppler but there’s a lot of fluid movement in the urine so I had trouble with artifact.
- We flushed the bladder thoroughly with saline, then instilled a bit of dilute lidocaine, and gave the cat a little dexamethasone due to the severe inflammation.
- I could not get that plaque to loosen even with aggressive flushing.
- Plaque did not drop to the other side when we stood the cat up.
- PU is not an option for this owner nor is surgical biopsy.
- QUESTIONS: Could this be an eosinophilic plaque? If so, and given lack of other options, would anyone put this cat on oral pred? I know this would not be ideal without a cellular dx BUT the owner has run out of money after 4 days of EC hospitalization and re-catheterizing 3 times. We need to try something different.
ADDENDUM: I had recommended a cytospin on the urine/saline we drew off the bladder via catheter after agitating bladder contents with hydropulsion of the saline through the catheter. rDVM just texted me to say that there were a ton of eosinophils in that sediment. However, pt now also has a nonregen anemia (23%) and leukopenia that wasn’t there two days ago.
Thoughts?
Comments
Great case Liz. This is an
Great case Liz. This is an interstitial cystitis pattern and i call it inflammatory bladder disease and in my experience int he rare case of getting bx they are usually eosinophilic or lymphoplasmacytic infiltrates with an occasional bladder lsa. If the owner signs off on it I would give a dexameth shot and document before and after 48 hours… Ive done this before to keep the ownmer from euthanizing and have seen the bladder completely normalize but i emphasize and document the need for sx b x first to justify the dex.
Any idea the length of
Any idea the length of urinary catheter that was in place as the bladder wall pathology may be secondary to irritation from the catheter. Seen anemia develop with severe eosinophilic cystitis.
Would treat with cortisone and valium for a couple of days as there may also be urethritis.
Remo – I thought of the idea
Remo – I thought of the idea that the cath might be causing the inflammation, but would there have been eosinophils in the sediment just with mechanical trauma?
Sadly, the owner decided to euthanize rather than give the Dex inj I recommended a chance to work. Sometimes not being in control of these cases sucks.
Also, I really don’t think we
Also, I really don’t think we have evidence to suggest that a single dex inj should NOT be given to cats that block multiple times and require multiple catheterizations. There’s so much inflammation in there, it seems intuitive as long as we are culturing and assessing for iatrogenic infection. I suspect a dex inj earlier in this cat’s 3 day ordeal might’ve prevented the re-blocking. Thoughts?
In humans two important
In humans two important causes of eosinphilic cystitis are allergies and bladder wall injury, so also feasible in your patient. As catherization does cause trauma, I do use oral prednisolone for a few days without any overt secondary infections. I would think that the most likley reason for UTI/bacteuria would be the catheter itself and not the cortisone.
Remo, do you always use a
Remo, do you always use a couple days of prednisolone? If you say yes, it will make me happy. I’ve been starting to think of myself as old school.
Yes I do.
Yes I do.
Thanks so much for weighing
Thanks so much for weighing in, Remo.