This 11-year-old indoor/outdoor FS DSH cat presented for lethargy and anorexia. The physical exam revealed a painful mid cranial abdomen and moderate pyrexia. The CBC revealed moderate neutrophilic leukocytosis with a left shift, while blood chemistry analysis revealed moderately elevated total protein and globulins with severe hyperglycemia. The elevation in total protein and globulins and leukocytoses were persistent on repeat analysis over a 48 hour period. The urinalysis revealed 3+ glucosuria, and moderately elevated WBC and RBC with no reported bacteriuria.
This 11-year-old indoor/outdoor FS DSH cat presented for lethargy and anorexia. The physical exam revealed a painful mid cranial abdomen and moderate pyrexia. The CBC revealed moderate neutrophilic leukocytosis with a left shift, while blood chemistry analysis revealed moderately elevated total protein and globulins with severe hyperglycemia. The elevation in total protein and globulins and leukocytoses were persistent on repeat analysis over a 48 hour period. The urinalysis revealed 3+ glucosuria, and moderately elevated WBC and RBC with no reported bacteriuria.
Case Study
Pancreatic neutrophilic and macrophagic inflammation in an 11 year old FS DSH cat
DX
Sonographic Differential Diagnosis
Moderate to severe pancreatitis with adjacent peritoneal inflammation. The significance of the pancreatic duct dilation is dubious, given the age of the animal and could be incidental or secondary to active pancreatic inflammation.
Image Interpretation
A moderately enlarged and hypoechoic pancreas is present. The pancreas is bordered by markedly echogenic mesenteric and omental fat. Mild dilation of the pancreatic duct is also noted.
Outcome
The patient responded partially over the following 6 weeks to hospitalization and then outpatient fluid and supportive therapy. Blood glucose levels were persistently uncontrollable and the owner selected humane euthanasia 7 weeks post sonogram. Underlying pancreatic neoplasia could not be completely ruled out based on cytology alone in this case.
Comments
No video is available on this patient.
Clinical Differential Diagnosis
Diabetes either primary or secondary to pancreatitis. Pancreas: pancreatitis, infectious disease, sepsis, lymphoma or other neoplasia, pancreatitis. Kidney: pyelonephritis.
Sampling
22 and 25-gauge US guided FNA of the pancreas revealed mixed neutrophilic and macrophagic inflammation with high cellularity. Concurrent liver FNA revealed similar suppurative inflammation with high cellularity. Biopsy was not performed due to poor clinical condition at the time of the exam.
Patient Information
Clinical Signs
- Anorexia
- Lethargy
Exam Finding
- Abdominal Pain
- Fever
Images
Blood Chemistry
- Globulin, High
- Glucose, High
- Total Protein, High
CBC
- Left Shift
- Neutrophils, High
- WBC, High
Clinical Signs
- Anorexia
- Lethargy
Urinalysi
- Blood Present
- Isosthenuria Present
- WBCs Present