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Černá P, Lopez‐Jimenez C, Fukushima K, Nakashima K, Nakagawa T, Adam F, Groth A, Denning A, Israeliantz N, Gunn‐Moore DA. Clinicopathological findings, treatment, and outcome in 60 cats with gastrointestinal eosinophilic sclerosing fibroplasia. J Vet Intern Med 2024; 38:1005-1012. [PMID: 38205893 PMCID: PMC10937490 DOI: 10.1111/jvim.16992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Gastrointestinal eosinophilic sclerosing fibroplasia (GESF) in cats presents as mass(es) associated with the gastrointestinal tract, mesentery, and abdominal lymph nodes. HYPOTHESIS/OBJECTIVES To report the clinicopathological findings, treatment, and outcome of cats with GESF. ANIMALS Sixty client-owned cats diagnosed with GESF. METHODS Retrospective review of medical records of cats with histopathologically confirmed GESF. RESULTS The median age was 5.4 years (interquartile range [IQR], 3.3-8.9.); 30% were Domestic Shorthairs and 12% were Domestic Longhair cats, with the most prevalent pedigree breeds being Ragdolls (25%), Exotic Shorthair (10%) and Persian (8%) cats. The median duration of clinical signs was 90 days (IQR, 17.5-247.0); the most common clinical signs were weight loss (60%), hyporexia/anorexia (55%), chronic vomiting (37%), lethargy (35%) and chronic diarrhea (27%). Masses were located in the small intestine (32%), stomach (27%), ileocolic junction (15%), colon (10%), lymph node (8%) and mesentery (8%) and 15% of cats had >1 mass. Eosinophilia was present in 50% and hypoalbuminemia in 28% of cats. The mass was removed surgically in 37% of cases. Most cats (98%) were treated with corticosteroids. Survival was not statistically different between cats treated with surgical resection and cats treated with medical therapy alone, 88% of the cats were still alive at the time of writing. CONCLUSIONS AND CLINICAL IMPORTANCE GESF is an important differential diagnosis for abdominal masses in cats, and has a much better prognosis than previously reported.
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Affiliation(s)
- Petra Černá
- Department of Clinical SciencesColorado State UniversityFort CollinsColoradoUSA
- Small Animal ClinicThe University of Veterinary Sciences BrnoBrnoCzech Republic
| | | | | | | | | | - Fiona Adam
- North Downs Specialist ReferralsBletchingleyUK
| | - Anna Groth
- North Downs Specialist ReferralsBletchingleyUK
| | | | - Nicolas Israeliantz
- The Royal (Dick) School of Veterinary StudiesUniversity of EdinburghMidlothianUK
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Wheatley MA, Stowe DM, Mochizuki H. Eosinophilic cavitary effusions in cats: 48 cases (2010-2020). Vet Clin Pathol 2023; 52:681-690. [PMID: 37788981 DOI: 10.1111/vcp.13295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/05/2023] [Accepted: 07/17/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Eosinophilic effusions are commonly defined as effusions with ≥10% eosinophils. Eosinophilic cavitary effusions are infrequently observed in cats, with few case reports comprising the majority of the recent literature. OBJECTIVE The objective was to review disease associations of cats with eosinophilic cavitary effusions and to assess if a lower threshold of eosinophils (5%-9%) may warrant consideration of similar etiologies associated with effusions with ≥10% eosinophils. METHODS Cytology reports were retrospectively reviewed for all feline cavitary effusions submitted for fluid analysis from 2010 to 2020 at a veterinary teaching hospital. Cases were included if the manual leukocyte differential included ≥5% eosinophils and separated into 5%-9% and ≥10% eosinophils groups. Patient records were reviewed for associated medical conditions. RESULTS A total of 669 effusions were submitted from 579 cats; 50 effusions from 48 cats had a leukocyte differential with ≥5% eosinophils. The eosinophil proportion was ≥10% in 22 cats; the most common underlying cause was neoplasia (10/22, 45%), followed by inflammatory disease (4/22, 18%), cardiac disease (3/22, 14%), suspect neoplasia (3/22, 14%), and undetermined (2/22, 9%). The underlying causes for the 26 cats with 5%-9% eosinophils were similar; neoplasia (8/26, 31%), cardiac disease (6/26, 23%), inflammatory disease (4/26, 15%), suspect neoplasia (3/26, 12%), undetermined (3/26, 12%), and idiopathic chylothorax (2/26, 8%). Cats with eosinophil proportions ≥10% in the fluid exhibited peripheral eosinophilia more frequently (35%) compared to those with 5%-9% eosinophils (5%). CONCLUSIONS Consistent with the current literature, neoplasia, particularly lymphoma, remains a primary consideration for cats with eosinophilic effusions. Previously unreported associated diseases included cardiovascular and inflammatory disorders. Our findings suggest an eosinophil differential of 5%-9% is seen with similar etiologies considered for classically defined eosinophilic effusions.
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Affiliation(s)
- Meagan A Wheatley
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Devorah M Stowe
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Hiroyuki Mochizuki
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
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Duclos AA, Wolfe A, Mooney CT. Intrathoracic eosinophilic sclerosing fibroplasia with intralesional bacteria in a cat. JFMS Open Rep 2023; 9:20551169231199447. [PMID: 37927535 PMCID: PMC10621301 DOI: 10.1177/20551169231199447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Case summary A 9-year-old neutered female domestic shorthair cat was presented for investigation of a cranial mediastinal mass. Moderate peripheral eosinophilia and mild-to-moderate polyclonal gammopathy were identified. A thoracoabdominal CT scan documented a cranial mediastinal mass encircling the trachea. Ultrasound-guided fine-needle aspiration and core-needle biopsy were performed, but cytology and histopathology were inconclusive. Surgical debulking was performed. Further histological samples identified severe pyogranulomatous and eosinophilic fibrosing mediastinitis, consistent with feline eosinophilic sclerosing fibroplasia. Gram staining and fluorescence in situ hybridisation (FISH) identified numerous Gram-positive coccoid bacteria. Eosinophilia and hyperglobulinaemia resolved after surgery and combined antimicrobial and immunosuppressive therapy. The cat died 3 months later after developing acute haemorrhagic diarrhoea and dyspnoea. Relevance and novel information Eosinophilic sclerosing fibroplasia is reportedly mainly confined to the gastrointestinal tract in cats. Less commonly, extragastrointestinal cases have been described. Lesions in the mediastinal or sternal lymph nodes have been reported, all in association with evident gastrointestinal involvement. The presence of pleural effusion was variable in these cases. To the authors' knowledge, this is the first report of eosinophilic sclerosing fibroplasia presenting due to lower respiratory signs in a cat. Intralesional bacteria were identified using Gram staining and FISH examination. The presence of intralesional bacteria in the normally sterile mediastinal tissue may support the involvement of penetrating injuries in the pathogenesis of the disease. Eosinophilic sclerosing fibroplasia should be suspected in any cat with abdominal and/or thoracic masses, particularly if associated with peripheral eosinophilia and polyclonal gammopathy.
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Affiliation(s)
- Antoine A Duclos
- Small Animal Clinical Studies, School of Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - Alan Wolfe
- Pathobiology, School of Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - Carmel T Mooney
- Small Animal Clinical Studies, School of Veterinary Medicine, University College Dublin, Dublin, Ireland
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Martineau M, Tilmant C, Risco Castillo V, Guillot J, Reyes-Gomez E, Benchekroun G, Freiche V. A case of feline gastrointestinal eosinophilic sclerosing fibroplasia associated with fungal colonisation: endoscopic features, treatment and follow-up. JFMS Open Rep 2023; 9:20551169231165246. [PMID: 37205163 PMCID: PMC10185866 DOI: 10.1177/20551169231165246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
Case summary A 5-year-old castrated male domestic shorthair cat presented with a 3-month history of weight loss, chronic diarrhoea and vomiting. Examination revealed a large proximal duodenal lesion eventually diagnosed as feline gastrointestinal eosinophilic sclerosing fibroplasia (FGESF) associated with fungal filaments. Histological examination was performed following endoscopic biopsy. Direct examination and mycological culture of the duodenal biopsies revealed the presence of a siphomycetous fungus, which was further identified as Rhizopus microsporus. Treatment with prednisolone and ciclosporin for 3 months led to complete resolution of the clinical signs and marked improvement of the endoscopic lesions. Specific fungal treatment with amphotericin B was poorly tolerated. Relevance and novel information To the best of our knowledge, this is the first report of the characterisation of a siphomycetous fungus associated with FGESF lesions, and the first endoscopic description and diagnosis of FGESF without surgical biopsies. We hypothesise that the presence of R microsporus occurred because of disrupted mucosal integrity.
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Affiliation(s)
- Michael Martineau
- National Veterinary School of Alfort, CHUVA,
Internal Medicine Unit, Maisons-Alfort, France
- Department of Internal Medicine, Frégis
Veterinary Hospital Centre, Arcueil, France
| | - Cyril Tilmant
- National Veterinary School of Alfort, CHUVA,
Internal Medicine Unit, Maisons-Alfort, France
- Department of Internal Medicine, Olliolis
Veterinary Clinic, Ollioules, France
| | - Veronica Risco Castillo
- Department of Parasitology and Mycology,
National Veterinary School of Alfort, BioPôle Alfort, Maisons-Alfort, France
| | - Jacques Guillot
- Department of Dermatology, Parasitology, and
Mycology, Oniris, Nantes, France
| | - Edouard Reyes-Gomez
- Department of Anatomical Pathology, National
Veterinary School of Alfort, BioPôle Alfort, Maisons-Alfort, France
| | - Ghita Benchekroun
- National Veterinary School of Alfort, CHUVA,
Internal Medicine Unit, Maisons-Alfort, France
| | - Valerie Freiche
- National Veterinary School of Alfort, CHUVA,
Internal Medicine Unit, Maisons-Alfort, France
- Valerie Freiche DVM, DESV-IM, PhD, Ecole Nationale
Vétérinaire d'Alfort, CHUVA, Unité de Médecine Interne, 7 avenue du Général de Gaulle,
Maisons-Alfort 94704, France
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Goffart LM, Durand A, Dettwiler M, Vincenti S. Feline gastrointestinal eosinophilic sclerosing fibroplasia presenting as a rectal mass. JFMS Open Rep 2022; 8:20551169221114330. [PMID: 35966900 PMCID: PMC9373184 DOI: 10.1177/20551169221114330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Case summary A 9-year-old neutered male cat was referred owing to dyschezia and weight loss. Abdominal CT revealed a heterogeneous mass in the rectum and thickening of one caudal mesenteric lymph node. The mass induced a focal rectal obstruction. Cytological evaluation of fine-needle aspirates showed signs of mixed inflammation for the rectal mass and a reactive lymph node. Because a definite diagnosis was not achieved, complete resection of the mass via a dorsal approach to the rectum was attempted. Histopathology confirmed complete removal and diagnosed feline gastrointestinal eosinophilic sclerosing fibroplasia (FGESF). The cat was treated with psyllium husks and lactulose after surgery. In the postoperative year, the owner reported normal behaviour, food intake and defecation of the patient. Dyschezia reoccurred 14 months after surgery. Imaging revealed recurrence of a rectal mass. Owing to clinical deterioration, the owner elected for euthanasia. Relevance and novel information This is the first report of rectal FGESF with dyschezia and weight loss as the main clinical signs. The case demonstrates an acceptable outcome for more than 1 year without additional immunosuppressive therapy, and emphasises that FGESF must be considered as a differential diagnosis for rectal masses in cats.
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Affiliation(s)
- Laura M Goffart
- Division of Clinical Surgery, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Alexane Durand
- Division of Clinical Radiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Martina Dettwiler
- Division of Clinical Pathology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Simona Vincenti
- Division of Clinical Surgery, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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Zampieri B, Church ME, Walsh K, Lennon EM. Feline eosinophilic sclerosing fibroplasia – a characteristic inflammatory response in sites beyond the gastrointestinal tract: case report and proposed nomenclature. JFMS Open Rep 2022; 8:20551169221117516. [PMID: 36003069 PMCID: PMC9393682 DOI: 10.1177/20551169221117516] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Case summary An adult male neutered Russian Blue cat presented for a right-sided nasal mass with
bilateral retropharyngeal and right mandibular lymphadenomegaly. Medial retropharyngeal
lymph node excision with nasal mass biopsy revealed eosinophilic sclerosing
lymphadenitis and eosinophilic and lymphoplasmacytic rhinitis, respectively. Bacterial
culture of the lymph node grew Pseudomonas aeruginosa, and treatment
with pradofloxacin was started. Despite initial improvement, clinical signs recurred
after 9 months, and fine-needle aspirates of the right mandibular and left medial
retropharyngeal lymph nodes showed eosinophilic and mastocytic infiltration. Bacterial
culture of the left medial retropharyngeal lymph node grew P
aeruginosa, and treatment with anti-inflammatory doses of prednisolone and,
later, marbofloxacin was instituted. Relevance and novel information This report describes a case of feline eosinophilic sclerosing lymphadenitis diagnosed
outside of the abdominal cavity and is the first case reported to be associated with
P aeruginosa. Feline eosinophilic sclerosing lymphadenitis should be
considered as a differential for lymphadenopathy occurring in areas other than the
abdominal cavity. Feline eosinophilic sclerosing lymphadenitis may develop in cats due
to a species-specific inflammatory response to chronic bacterial and fungal
infections.
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Affiliation(s)
- Bianca Zampieri
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Molly E Church
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Koranda Walsh
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth M Lennon
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Porras N, Rebollada-merino A, Rodríguez-franco F, Calvo-ibbitson A, Rodríguez-bertos A. Feline Gastrointestinal Eosinophilic Sclerosing Fibroplasia—Extracellular Matrix Proteins and TGF-β1 Immunoexpression. Vet Sci 2022; 9:291. [PMID: 35737343 PMCID: PMC9227513 DOI: 10.3390/vetsci9060291] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/23/2022] [Accepted: 06/11/2022] [Indexed: 11/17/2022] Open
Abstract
Feline gastrointestinal eosinophilic sclerosing fibroplasia (FGESF) has been described as an inflammatory disorder with an eosinophilic component with etiopathogenesis that is still unknown. Sixteen intestinal samples from two veterinary diagnostic services (2014–2017) were included in the study. A histopathological criterion classified the cases into three grades (mild, moderate, and severe) according to the distribution of the lesions and the course. An immunohistochemical study of collagen I, collagen III, fibronectin, and transforming growth factor β1 (TGF-β1) was performed in each case. An immunohistochemical study of mild grades shows greater collagen III immunoexpression, compared to collagen I and fibronectin, which suggests an “early” stage of fibrosis. In more intense grades, an increased immunoexpression of collagen I, compared to collagen III, suggests a “late” stage of fibrosis. Otherwise, the highest expression of TGF-β1 was observed in the moderate phase, due to the high proliferation of reactive fibroblast and intense inflammation. The results suggest that the inflammatory infiltrate is the trigger for the elevation in TGF-β1, altering the collagen type III:I ratio. In conclusion, immunohistochemical studies can be a very useful method in diagnosing cases of FGESF of mild grades and could help to apply a differential diagnosis regarding feline eosinophilic chronic enteritis (CEE) in the context of inflammatory bowel disease (IBD).
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Davidson GA, Taylor SS, Dobromylskyj MJ, Gemignani F, Renfrew H. A case of an intramural, cavitated feline gastrointestinal eosinophilic sclerosing fibroplasia of the cranial abdomen in a domestic longhair cat. JFMS Open Rep 2021; 7:2055116921995396. [PMID: 33747539 PMCID: PMC7905731 DOI: 10.1177/2055116921995396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Case summary A 5-year-old neutered male domestic longhair cat was presented for the investigation of a cranial abdominal mass following a 1-month history of inappetence and lethargy. Abdominal ultrasound revealed a large cavitated mass confluent with the mesenteric aspect of the descending duodenum. At surgery, the mass was found to involve the pylorus, proximal duodenum and pancreas, and was non-resectable. Histopathological examination of surgical biopsies revealed a non-neoplastic process involving eosinophils and fibroplasia. Relevance and novel information This case report describes an uncommon feline gastrointestinal pathology with an unusual appearance that may provide an additional differential diagnosis other than neoplasia or abdominal abscess when confronted with a cavitated abdominal mass in cats.
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Abstract
PRACTICAL RELEVANCE Abdominal ultrasound plays a vital role in the diagnostic work-up of many cats presenting to general and specialist practitioners. B-mode ultrasonography is likely the most widely used modality for imaging the gastrointestinal (GI) tract in cats and it can help in the diagnosis of GI masses, foreign bodies and disorders of the ileocaecocolic junction. CLINICAL CHALLENGES Despite ultrasonography being a commonly used modality, many practitioners are not comfortable performing an ultrasound examination or interpreting the resulting images. Even differentiating between normal variations and pathological changes can be challenging for all but the most experienced. For example, while for inflammatory conditions of the feline GI tract changes are frequently identified on ultrasound, there may occasionally be no changes to the appearance of the intestine; hence a 'normal' ultrasound does not exclude the possibility of inflammatory disease. AIM This review, part of an occasional series on feline abdominal ultrasonography, describes the appearance of a range of conditions that affect the feline GI tract; the normal GI tract is addressed in an accompanying article in this issue of JFMS. Aimed at general practitioners who wish to improve their knowledge and confidence in feline abdominal ultrasound, this review is accompanied by high-resolution images and videos available online as supplementary material. EQUIPMENT Ultrasound facilities are readily available to most practitioners, although use of ultrasonography as a diagnostic tool is highly dependent on operator experience. EVIDENCE BASE Information provided in this article is drawn from the published literature and the author's own clinical experience.
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Affiliation(s)
- Sally Griffin
- Radiology Department, Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull B90 4NH, UK
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Thieme ME, Olsen AM, Woolcock AD, Miller MA, Simons MC. Diagnosis and management of a case of retroperitoneal eosinophilic sclerosing fibroplasia in a cat. JFMS Open Rep 2019; 5:2055116919867178. [PMID: 31452913 PMCID: PMC6699013 DOI: 10.1177/2055116919867178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Case summary A 4-year-old neutered male cat was presented with a 2-month history of
intermittent constipation that progressed to obstipation. Primary clinical
findings included a large, multi lobulated mass in the caudodorsal abdomen,
peripheral eosinophilia and hyperglobulinemia. Abdominal imaging revealed a
multilobulated, cavitated mass in the sublumbar region. Exploratory
celiotomy revealed multiple firm masses in the sublumbar retroperitoneal
space causing ventral displacement and compression of the descending colon
with extension of the masses into the pelvic canal. Histopathology was
consistent with feline gastrointestinal eosinophilic sclerosing fibroplasia
(FGESF). Aerobic culture was positive for Staphylococcus
aureus. The cat was treated with prednisolone (2 mg/kg PO
q24h), lactulose (0.5 g/kg PO q8h), amoxicillin/clavulanic acid (62.5 mg/cat
PO q12h for 1 month) and fenbendazole (50 mg/kg PO q24h for 5 days). Six
months postoperatively, the cat had no recurrence of clinical signs. Repeat
evaluation and imaging at day 732 postoperatively revealed marked
improvement of the abdominal mass, resolution of peripheral eosinophilia and
no clinical signs with continued prednisolone therapy (0.5 mg/kg PO
q24h). Relevance and novel information This is a report of a primary extramural FGESF lesion, and the first
description of characteristics of FGESF on CT. Previous evidence suggests
that the most favorable outcomes require immunosuppressive therapy and
complete surgical excision; however, this case demonstrates a favorable
outcome with medical management alone.
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Affiliation(s)
- Maureen E Thieme
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, USA
| | - Anastasia M Olsen
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, USA
| | - Andrew D Woolcock
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, USA
| | - Margaret A Miller
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, USA
| | - Micha C Simons
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, USA
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Pinte L, Baicuş C. Causes of eosinophilic ascites – A systematic review. Romanian Journal of Internal Medicine 2019; 57:110-24. [DOI: 10.2478/rjim-2018-0041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Indexed: 12/17/2022] Open
Abstract
Abstract
Background
. In the last years an uprising interest for a relatively unknown entity, eosinophilic ascites (EA), has been recorded.
Our aim is to investigate the potential causes of EA development, as well as clinical, laboratory, endoscopic and radiologic features, management and outcome in these patients.
Methods
. The following research was performed on PubMed (MEDLINE) database using the medical subject headings [Mesh] terms “Ascites” AND “Eosinophils”.
Results
. A total of 284 results, dating from 1962 onwards, were found and abstracts were examined. 131 papers were excluded and the remaining 153 publications, consisting in case reports and series of cases, were analyzed.
From 171 patients with EA, 127 subjects (74%) had EGE, 17 (10%) parasitic and fungal infections, 11(7%) Hypereosinophilic syndrome and 16 patients (9%) less common diseases (eosinophilic pancreatitis, chronic eosinophilic leukemia, myelofibrosis, T-cell lymphoma, Churg Strauss Syndrome, Systemic lupus erythematosus, Familial paroxysmal polyserositis and Ménétrier’s disease). High eosinophil blood count and IgE levels as well as gastrointestinal symptoms are frequent. The diagnosis is based on ascitic fluid analysis, imaging and endoscopic biopsies. Therapy with corticosteroids results in resolution of eosinophilic ascites in almost all patients.
Conclusion
. In most cases, in the absence of allergy, parasitic infections, malignancy, hematological disorders, peritoneal tuberculosis, inflammatory bowel disease or autoimmune disease, EA develops as a manifestation of eosinophilic gastroenteritis.
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