Page 10 - Clinical Connections - Spring 2023

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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our feedback is essential in making months in employment. If you employ an RVC BSc/
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For small animal referrals, please call:
01707 666399
Email:
qmhreception@rvc.ac.uk

10 Spring 2023