Advice re feline uveitis

T.C.

The Living Force
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One of our beloved cats has had a health issue ongoing over the last six months. Periodically he will become very lethargic and stop eating. The first time this happened, we took him to the vet. They thought maybe it was a stomach issue and gave him some antibiotics and within a day or so he was back to normal.

This has recurred every couple of months. The second time we used an app to speak to an online vet who advised us to just try him with some chicken and if he didn’t perk up, take him in to a vet. Again, within a couple of days he was back to normal.

It happened a couple more times, but since we got used to it, we just observed him and let it pass. But a few weeks ago, it got quite bad again and on the third day, we took him in to the vets again; this time a different clinic with a new vet. He was kept in, put on a drip, given a metacam (NSAID) injection, and bloods were taken and sent away for analysis. While he was in, the vet had noticed he seemed to have a problem with his eyes. She diagnosed it as uveitis, probably a secondary symptom of an underlying, problem; hence the blood work.

We brought him home that night, and he ate. For a couple of days, he seemed better, but started to slip back into the lethargy and loss of appetite. We took him back to the vets and she said it was probably the pain of the uveitis, and the NSAID had worn off. We got it in a suspension form and after putting it in his food he improved again.

One time it was me who took him to the vet, another time it was my wife. The same with a couple of telephone calls. We shared with each other everything we could remember about what the vet and receptionist had said.

Eventually when all tests came back, he was clear of the most serious possible causes, but toxoplasmosis was determined to be the problem. So we got some antibiotics for him which he has been having for about one week and continue on for the next three.

The thing is, last night and then today, his lethargy and loss of appetite have come back. I rang the vet again and have booked him in for an appointment tomorrow morning.

I was wondering if any members with experience in the field have any feedback on the situation so far. I was hoping that since they diagnosed toxo, and gave him the antibiotics, that it would help with the uveitis and prevent it from reoccurring? So now I don’t know if it’s a misdiagnosis. I’m assuming the uveitis is what’s bothering him again.

Thanks
 

Arwenn

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I’m not a vet, but as an optometrist treating human eyes, topical corticosteroids are prescribed for anterior uveitis (also known as iritis), along with antimicrobials if required. Below is a link for Ocular Toxoplasmosis in humans, with associated inflammatory conditions such as uveitis and how it is treated. Perhaps you ask the vet if topical steroid drops might help? Best wishes with the vet, I hope your cat gets better soon :hug2:

 

Alejo

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Oh, I am so sorry to learn this TC, how old is your cat? I think that's another factor to consider.

If he is older, then he may be simply going through the motions of age, or maybe he is eating something he's allergic to? My dog tends to have lethargic days and his stomach is very sensible to any deviation from his regular diet. And for the most part, whenever he goes through one of these episodes, it's him getting into something he wasn't supposed to and trouble ensues.

Without knowing much about cats, I'd say probably the best thing would be to wait for the diagnosis from the Vet.

Did the last antibiotic treatment you mentioned get prescribed by the vet? or was it something you guys took upon yourselves? either way it could also be something in the pills that he's reacting badly to.

I hope you find some answers tomorrow and that your kitten gets some respite from whatever is troubling him.
 

T.C.

The Living Force
FOTCM Member
@Arwenn He was initially given some Pred Forte eye drops, but after three days, the cloudiness in his eyes appeared to worsen. My wife had a telephone consultation with the vet about it and she advised us to stop using them as it was possibly a negative side effect. Thanks for the link. I’ll read it.

@Alejo Del is relatively young at three years old, which adds to our distress since when he’s well, he has lots of energy, a good appetite, and is affectionate.

The script for the clindamycin was written by our vet, and we acquired the suspension through a reputable online site.

My hope with the upcoming appointment is for the vet to administer an injection to relieve the pain so that he can start eating again and resume oral treatments at home via his meals, and for them to check his hydration and temperature. Then I want to find out whether he definitely tested positive for toxo or if they came to that conclusion through a process of eliminating the other, more serious cat viruses that cause uveitis. (We’re 99% he did test positive for it, but due to the fact that it’s been me or my wife getting the information on different occasions and sharing it with each other, there’s a chance we misunderstood something at some point.)

My main question is, is it possible that there could be another flare up of the uveitis if the cause is ocular toxoplasmosis after a week of clindamycin. Or does the fact that he’s been taking the clindamycin, and it’s flared up again, indicate that the uveitis is being caused by something else.
 

T.C.

The Living Force
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My main question is, is it possible that there could be another flare up of the uveitis if the cause is ocular toxoplasmosis after a week of clindamycin. Or does the fact that he’s been taking the clindamycin, and it’s flared up again, indicate that the uveitis is being caused by something else.

@Arwenn It says in the paper you linked me:

“Recurrences

“Following primary infection, recurrences of ocular infection are common. They are managed in the same manner as primary infection”

The way that’s worded, it implies the primary infection was treated, which would suggest that it’s entirely possible that the diagnosis of ocular toxo in Del is correct.

I’ll report back after we’ve seen the vet.
 

Arwenn

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My wife had a telephone consultation with the vet about it and she advised us to stop using them as it was possibly a negative side effect.
Steroid drops can cause cataract and increased eye pressure (glaucoma) as side effects, so it’s prescribed very carefully and under supervision.
The way that’s worded, it implies the primary infection was treated, which would suggest that it’s entirely possible that the diagnosis of ocular toxo in Del is correct.
Looks that way, but I guess until you see the vet you won’t know for sure. I hope the vet can prescribe something to ease the pain & inflammation so he can start eating again. All the best to you for your cat, let us know how you go. :hug2:
 

T.C.

The Living Force
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It’s definitely ocular toxo; he tested positive for it and there’s no toxo in his bloodstream. No antibodies for feline corona, negative for everything else that can cause uveitis.

It’s possible that there will be other flare ups, but there’s a good chance that by the end of the course of clindamycin that the toxo will be gone. It is a sophisticated enough parasite though that the clindamycin might not do the trick, and we’d have to look at other treatments.

The vet gave him a metacam injection and he’s perked up again and has just had some breakfast (phew). She put a dye into his eyes to determine the risk of continuing to use the Pred Forte, and there’s no ulcers or lesions.

So we’ve come away with metacam and prednisolone suspensions. There was discussion about whether to use oral steroids instead of the metacam, in order to reduce the inflammation and get his temperature down. This would be suppressing his immune system though, so we decided to go with the metacam for now (since it’s also an antipyretic), rather than compromise his natural ability to fight infections.

If over the next couple of weeks, he keeps having flare ups of the uveitis and increased temperature, then we’ll probably need to look at changing the treatments completely, attack the toxo via different meathods and manage the other symptoms with steroids.
 

PERLOU

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Je suis contente de lire ces nouvelles CT pour ton petit ange...
J'espère qu'il va mieux manger et retrouver de la force et de l'appétit...
Prends bien soin de vous deux... Je t'embrasse et une caresse au petit amour...

I am happy to read these new CT for your little angel...
I hope he will eat better and get his strength and appetite back...
Take good care of you both... I kiss you and give a hug to the little love...
 

lainey

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I'm so sorry to hear about your wee kitty. It seems like you've done your research though and you're doing your best to get them the help they need. Fingers crossed they pull through quickly.
 

Keit

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There was discussion about whether to use oral steroids instead of the metacam, in order to reduce the inflammation and get his temperature down. This would be suppressing his immune system though, so we decided to go with the metacam for now (since it’s also an antipyretic), rather than compromise his natural ability to fight infections.

You probably were told by the vet, but just make sure to never give both steroids and antiinflammatory drugs together or on the same 24 hour period. The combination has a grave effect on the stomach lining.

Btw, the symptoms you describe look a lot like FiP. But then you said that you tested your kittie for coronavirus and there were no antibodies. I am still curious about his blood work, beochemistry results.

And good luck to your kitty! Looks like you indeed do your research. :flowers:
 

PERLOU

The Living Force
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Merci Keit, je suis rassurée de savoir que vous gardez votre oeil affectueux et vigilant sur ce petit ange...

Thank you Keit, I am reassured to know that you keep your loving and vigilant eye on this little angel...
 

T.C.

The Living Force
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@Keit I asked the vet if there was the possibility of an interaction between the steroid eye drops and the oral NSAID and she said no. Would you agree with her on that?

Yes, regarding the FiP, she said the result was literally zero antibodies. Blood work showed inflammation, she said something about proteins, and I didn’t understand it, but I think she said it was low and that was good? Negative for immunodeficiency, and leukaemia. Positive for toxoplasma gondii, but wasn’t systemic, if I understand that correctly?

Thanks for your input, and to everyone else!
 

Alejo

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Awesome TC,

I am glad you at least have a direction to move towards, I hope it goes well and your kitty feels better soon, such a young baby too.
 

T.C.

The Living Force
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Just an update on how Del’s been since we came back from the vets, but I’m mainly sharing it as advice and a warning to others about always trying to do your best to stay aware and remember to tread carefully when it comes to medical treatments.

I mentioned previously that Del was kept in at the vets a few weeks ago, when he was diagnosed with uveitis and they first took the bloods. At that time, he was given a metacam injection and treated with prednisolone eye drops. We think he probably had a dye put into eyes to check them as well.

We brought him home that night, and some point over the next day or two, we noticed that his eye sight appeared to have gotten very bad. At the time, having just been told that he had an eye condition, we put it down to that. After another 24hrs or so, he eye sight seemed to return to normal. During that time, his pupils were constantly dilated.

The same thing has happened upon his return from the latest appointment. This time it was even worse though. He effectively went almost totally blind. Couldn’t find his way around the house. Would find the walls and then follow them in order to navigate.

It being the second time it had happened, and that his eye sight was fine when we took him in, the penny dropped for me and my wife, and we realised he’s had some sort of negative reaction to either one of his treatments, or a combination of them together.

We started to research the eye drops, the metacam, and the eye dye he was given again this time. It turns out that in the US, the FDA does not approve the repeated use of metacam in cats. Oral suspension has not been shown to be safe under any circumstances, and the injection is only to ever be given once before operations. The drug has been shown to cause renal failure and death in cats.

There are side-effects to the prednisolone, of blurred vision, pupil dilation, etc.

I couldn’t find any serious side effects to the dye.

We’ve decided to stop both the metacam and the prednisolone eye drops, have spoken again to the vets and tomorrow we are going to change to oral steroids instead and see how he goes with that.

We both had a lot of guilt when we realised he’d gone blind again due to the fact that it happened before and we didn’t pick up on exactly why. We had to do a bit of ‘Work’ together to get past it and tell ourselves that we’ve been as thorough as we could and made each decision based on the information we had in each moment. And that we’re actively making new decisions based on new information.

Last night, the dilation of his pupils had lessened, and this morning and today, his vision has massively improved.

I just wanted to let people know about it just to serve as a lesson to always be as observant as possible, ideally try to keep some notes or diary entries about when you start treatments, and always, always watch out for side-effects; because it never occurred to us that the reason for his initial loss of sight was due to medications. We were so happy that his pain had been relieved and he was eating again, that the positive effect of the treatments blinded us (hmm, no pun intended, but interesting that term came out) to the negative effects.
 
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