A challenging case: An emaciated cat with abdominal distention


A challenging case: An emaciated cat with abdominal distention

This outdoor cat's severely distended abdomen and weight loss were the most obvious manifestations of numerous internal problems.

Vital Stats
A 9-year-old neutered male domestic shorthaired cat had been presented to the referring veterinarian for evaluation of lethargy and weight loss. The cat lived exclusively outdoors and had been vaccinated twice in the previous three years (the last time being six months before presentation) against rabies, feline viral rhinotracheitis, feline caliciviral infection, chlamydiosis, and feline panleukopenia. The owners were able to observe the cat daily when it came to the house to be fed. A complete blood count and serum chemistry profile had revealed anemia (hematocrit = 16.6%; reference range = 24% to 45%), hypoalbuminemia (2.05 g/dl; reference range = 2.6 to 3.9 g/dl), hyperglobulinemia (6.29 g/dl; reference range = 2.8 to 5.1 g/dl), and an elevated total white blood cell count (28.3 × 109/L; reference range = 5 to 18.9 × 109/L). The referring veterinarian had prescribed clindamycin, and the cat had improved.

Four months later, the cat had been presented to the referring veterinarian because of constant vocalization and severe abdominal distention. The owners had noticed that the cat had become increasingly lethargic and anorectic and was vomiting. The results of a complete blood count and serum chemistry profile had been similar to those before except for a further increase in the total white blood cell count. At both visits to the referring veterinarian, the results of enzyme-linked immunosorbent assays (ELISAs) had been negative for feline leukemia virus (FeLV) antigen and feline immunodeficiency virus (FIV) antibody. The cat was subsequently referred to The University of Tennessee's College of Veterinary Medicine for evaluation of severe abdominal distention.

Initial physical examination and diagnostic procedures

Laboratory Test Results
On initial physical examination, the cat was depressed and emaciated, weighing 4.6 lb (2.1 kg). It was hypothermic, with a rectal temperature of 94.5 F (34.7° C). The cat's heart rate was 150 beats/min, and its respiratory rate was 24 breaths/min. The cat's mucous membranes and sclerae were mildly icteric, and the cat was estimated to be 7% to 10% dehydrated. A grade II/VI systolic murmur was auscultated at the left sternal border; lung sounds were normal bilaterally. Femoral arterial pulses were palpably weak. The cat's abdomen was greatly distended and tympanic when percussed. Subcutaneous emphysema was present bilaterally along the dorsal aspect of the caudal thorax and cranial abdomen. Diffuse ulceration was present on the tongue's dorsal surface. An ophthalmologic examination revealed severe chorioretinitis in the left eye and a collapsed globe, a collapsed uvea, hyphema, and a hypermature cataract in the right eye. Initially, we suspected that the subcutaneous emphysema and abdominal distention were due to the free gas in the abdomen. Initial supportive care was instituted and included intravenous fluid administration while diagnostic tests were being done.

Abnormal complete blood count results included a nonregenerative, hypochromic anemia; leukocytosis; neutrophilia with a mild left shift; and lymphopenia (Table 1). Serum chemistry profile abnormalities included an elevated blood urea nitrogen concentration, hypoalbuminemia, hyperglobulinemia, hyperbilirubinemia, mild hyponatremia, and elevated aspartate transaminase activity (Table 1). A urine sample was not obtained at initial presentation because of the cat's tympanic abdomen and suspected pneumoperitoneum. The results of FeLV and FIV ELISAs were negative. The result of an ELISA for Dirofilaria immitis antibody was negative, and the result of an ELISA for D. immitis antigen was weakly positive. An IgM antibody titer for Toxoplasma gondii was less than 1:512 (greater than or equal to 512 is suspect), and the IgG antibody titer was 1:8,192 (greater than or equal to 32 is considered positive). A Western blot to detect antibody to Bartonella henselae, Bartonella clarridgeiae, and Bartonella koehlerae measured +3 (immunoblot grade = +1 to +4), indicating strong reactivity and possible infection.