Feline atypical mycobacterial panniculitis: Treatment, monitoring, and prognosis - Veterinary Medicine
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Feline atypical mycobacterial panniculitis: Treatment, monitoring, and prognosis
Antimicrobial therapy is indicated in all cats with this disfiguring disease. Surgical therapy can be added depending on the severity of the lesions. These clinicians offer guidance on selecting the right treatment method for each cat.


VETERINARY MEDICINE



4. A cat with recurrence of lesions on the lateral abdomen and ventral abdomen six weeks after aggressive surgical excision (the cat head is to the left and the ventral aspect of the abdomen is toward the bottom of the photo). The arrowheads are pointing to the draining tracts. The cat had received an antibiotic postoperatively for a minimum of three weeks.
If multiple lesions exist, surgical excision can be staged, with early surgical removal being performed on those lesions that can easily be excised and closed. Medical treatment is initiated for four to six weeks after you receive the results of histologic examination and bacterial culture and antimicrobial sensitivity testing. After this four to six weeks, the remaining wounds can be evaluated for surgical removal.


5. The same cat as in Figure 3 (the cats head is to the right of the photo). The lesions recurred as drain­ing tracts (arrowheads) despite aggressive surgical ex­ci­sion and use of a caudal superficial epigastric flap.
Some reports in the veterinary literature advocate omentoplasty to treat chronic wounds in cats (Figure 3).13-15 The functions of the omentum include fibrinolysis, tissue adhesion, angiogenesis, immune surveillance, and lymphatic drainage.13-18 In one retrospective study involving five cats with chronic skin lesions that were treated with omentoplasty, complete and uneventful healing occurred in all five cats.15 The mean follow-up time in the study was 2.5 years. Another retrospective study involving chronic axillary wounds in 10 cats that were treated with omentoplasty found that a long-term cure was achieved in seven cats.13 These reports suggest that in cats with chronic wounds, omentoplasty may be valuable and should be considered. Despite radical surgical excision of diseased tissue, recurrence in cats with AMP is high (Figures 4 & 5). Owners must be warned of the potential for recurrence before surgery. These surgeries typically require referral.

Therapeutic monitoring and prognosis

After initiating medical therapy, reevaluate cats with a clinical examination once or twice a month. In patients with improving lesions, continue the current treatment and monitoring protocol for three to six months, or one or two months beyond the resolution of all lesions. Cats that experience initial, but incomplete clinical improvement that later plateaus should be examined on a biweekly basis. If lesion resolution is not appreciated over an additional four-week period, consider adjunctive surgical débridement of the affected areas and continue antimicrobial monotherapy.1,7 In cats with AMP that suffer from progressive cutaneous disease despite treatment with an appropriate antimicrobial, perform additional tissue biopsies and cultures with antimicrobial sensitivity testing to confirm the diagnosis and document the development of potential antimicrobial resistance. In our experience, these difficult cases are best treated with both surgery and long-term, combination antimicrobial treatment based on the susceptibility patterns obtained from the most recent biopsy. The overall prognosis for cats with AMP remains guarded.

Summary

Because of medical and surgical advances that allow for an earlier and more accurate diagnosis and safer, more aggressive treatment, feline AMP should be considered a manageable and potentially curable disease.1,7 Consistent and thorough patient monitoring and client communication are paramount to successful long-term outcomes. The chronic nature of this disease requires that the owner of a cat with AMP be adequately prepared for the time, potential disappointment, and financial commitments associated with treatment. Unsuccessful treatment or no treatment results in disease progression, debilitation, pain, and death or euthanasia.

Thomas O. Manning, DVM, MS, DACVD
John H. Rossmeisl Jr., DVM, MS, DACVIM (internal medicine and neurology)
Otto I. Lanz, DVM, DACVS
Department of Small Animal Clinical Sciences
Virginia-Maryland Regional College of Veterinary Medicine
Virginia Tech
Blacksburg, VA 24061


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Source: VETERINARY MEDICINE,
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