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Google’s search for answers is over!
5 June 2015
Google is a 4 year old Siamese cat. He had been fairly healthy for most of his life, with only the diagnosis of feline asthma to contend with. However, around Christmas of 2014, Google’s owner started to notice scabs around his ears. As Google was seemingly unaware of these scabs, and as he was not showing any signs of being ill, Google’s owner was not initially worried. This changed soon after though when crusts, scabs and ulcers started to appear over Google’s face and he was taken to his local vets.
The cause for the crusting was not immediately obvious, but Google was prescribed antibiotics in case the skin had become infected. When he returned a week later, Google’s skin disease was even worse, with crusts and sores all around his mouth. His lymph nodes (glands) under his chin were also enlarged and tender. Google’s vets took samples from his skin for analysis and prescribed some steroid and antibiotic medication for his ears and skin whilst results were pending. These treatments improved Google’s skin problems substantially, so the courses were completed and then stopped. However, all the test results came back without being able to identify the cause of Google’s skin problems.
A month later, skin lesions returned with a vengeance, with crusts and sores all over the face, ears, tummy and around his bottom. With the trigger for Google’s skin disease remaining a mystery, Google was referred to Willows to see Dermatology Specialist Jon Hardy. Google’s unusual skin lesions were examined in detail, and samples of the crusts were analysed under a microscope. This showed large numbers of inflammatory cells called neutrophils but no bacteria or yeast organisms. Cells of the deeper layers of the skin were also seen amongst this material, suggestive of a disease affecting the integrity (the cells lose their attachments to one another) of Google’s skin. This loss of integrity can occur in cats where a disease causes the body’s immune system to function abnormally.
Biopsies of Google’s skin were therefore recommended, and he was anaesthetised so that very small samples of his skin could be taken for analysis by a pathologist. Knowing that some immune-mediated diseases can be triggered by internal problems such as tumours, Google also underwent scans whilst he was asleep. Willows Diagnostic Imaging Specialist Paul Mahoney performed an ultrasound examination of Google's tummy, and a CT scan was performed of Google’s chest. Encouragingly, no signs of internal disease triggers were found. Blood samples were also collected from Google, but revealed no changes that could be linked to the development of skin problems.
Google returned home to await the results of the biopsies, which came back within days, confirming the suspicion of an immune system problem. Google was diagnosed with a disease called pemphigus foliaceus. This occurs when the body’s own immune system starts attacking the cells of the skin. The skin then becomes inflamed and the cells lose their attachments to one another resulting in pus-filled spots, sores and scabs. Although this disease usually cannot be cured, treatment aims to control it with drugs to reduce the inflammatory attack and return the skin to normal. The vast majority of cats with this disease respond well and tolerate the medications without problems. Google was therefore started on anti-inflammatory steroid medication.
Google returned to Willows after 4 weeks on this treatment, and we are delighted to report that Google responded fantastically well. In fact, there were no skin lesions at all following the 4 weeks of treatment, so the dose of his medication is currently being reduced down to the lowest possible level. It is hoped that Google will remain free of crusty skin lesions and sores for a long time to come!
Google's skin lesions at presentation
Google after 4 weeks of steroids