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Eosinophilic Granuloma Complex
Eosinophilic granuloma complex therapy
Eosinophilic granuloma complex and ringworm
Eosinophilic granuloma complex
also see Skin problems
also see Lumps in cats
Eosinophilic Granuloma Complex therapy and loss of smell
Question: We have been consulting our vets (one GP, one Oncologist) but neither has an answer.
Our 5-yr old male (neutered) Maine Coon is undergoing treatment for an
eosinophilic granuloma on the roof of his mouth. First appearance of the
sore was in July, 1999. It was removed for biopsy (benign) down to the bone
in the center; healed over 3-4 months, then granulama began growing back.
We saw several vets till we found one who referred us to the Veterinary
Oncologist.The current treatment includes one dose of Strontium radiation therapy
(just under 1 month ago), prednisolone (was 10 mg per day, then reduced to
5 mg per day, back up to 10 mg per day today), and Leukeran (1 mg,
currently every three days).The cat has developed an oral-nasal fistula. Noisy breathing, etc. We
discovered this about 10 days ago. We started him on Clavamox (2x daily) 10
days ago. Seven days ago the cat stopped eating. He _wants_ to eat but
doesn't seem to be able to smell anything. (Not only food; normally he
hates banana; his reaction to a very ripe banana was "is it a toy or what?")We're giving him cyproheptidine as an appetite enhancer; the appetite is
enhanced but the sense of smell isn't so now he's crying and appears
anxious and has tried to devour a toy mouse but he's still not eating
unless I force feed.Today our oncologist sedated the cat and checked his nose. There is no
indication of the granuloma in the nose. Nothing up there but a little
blood. She doesn't want to close the fistula until the traces of the
granuloma are completely gone.But he's not eating on his own.
Any suggestions or ideas of where I can turn would be appreciated.
- Vicki (for Warrl)
Answer: Vicki-
I have seen recommendations to try radiation therapy for stubborn
eosinophilic granuloma lesions but have not had reason to resort to this
therapy, yet, in our practice. I think I would hesitate to do that, due to
the potential for complications such as those your cat is experiencing.
However, this decision has already been made.I hesitate to make the only suggestion I can think of, since your cat has
already been through a lot, but this is a time when it may be necessary to
consider placement of an esophageal or gastric feeding tube to support your
kitty until surgery can be performed and perhaps during the post-surgical
recovery period. I am not an expert on chemotherapy or radiation therapy,
by any means, but I have been to a couple of seminars on oncology at which
the speakers said that cats that stop eating during radiation or
chemotherapy do much better if feeding tubes are used to provide nutrition.Esophageal feeding tube are pretty easy to place and to maintain, so they
are becoming more popular in cats than stomach tubes implanted directly
into the stomach (gastrostomy tubes). Feeding tubes are a scary proposition
but they can improve the quality of a sick cat's life very much.We have been able to control eosinophilic granulomas, so far, in all of our
patients, using oral or injectable corticosteroids (such as prednisone or
methylprednisilone) or megestrol acetate. We try not to use megestrol
acetate until we are desperate, due to side effects associated with it,
such as a tendency to induce diabetes. Chlorambucil (Leukeran Rx) is one
of the medications also recommended for this condition. We have not used
it, yet, either.We have two patients whose eosinophilic granulomas return within a few
weeks to a few months of stopping therapy for them and have done so for
years. These can be a very frustrating problem. You may have to figure out
a long term strategy after getting through the immediate problems.I hope that your guy does better soon.
Mike Richards, DVM
1/31/2000
Eosinophilic granuloma complex and Ringworm
Question: Dear Dr. Richards,
A skin biopsy on our 1 year old male cat performed by the animal shelter we
adopted him from 6 months ago was suggestive of eosinophilic granuloma
complex. At the time, it manifested itself primarily by patches of hair
loss on his face. He was given three steroid shots---one shortly before we adopted
him and two shortly thereafter by my vet. The underlying cause for the
EGC has not been determined. He does not have (and did not have ) fleas. I have
never seen him scratch; his face does not ever appear to be itchy. The shelter put
him on a hypoallergenic diet. Although it was interrupted after an
estimated 4 weeks (b/c he got very sick), he did not improve during the time he was on it. He
always eats on, and drinks from, a ceramic dish--not plastic. (He got
very sick when he was exposed to some virus or bacteria ( the cause could not be determined) at
the same time his immune system was apparently suppressed presumably
as a result of the steroid shots (he had 106-107+ degree temperature for 4
days and was in the hospital for 7 days)). In the meantime, we realized he had
ringworm, which we fought over four months primarily with griseofulvin
(supplemented by a bath once a week for five weeks). (I should note he
had CBCs every two weeks during the griseofulvin regimen and the results were always
normal.) While I suspected the EGC was really ringworm, toward the end of
the ringworm battle, he began to show some hairloss under his whiskers and his
skin where the hair loss was somewhat crusty and plaque-like; my vet said that she
thought that it was a manifestation of EGC. Now, a month later, his lower
left lip has become swollen, red and looks crusty, and there has been some hair
loss in the patch of skin just under his mouth . My vet said she thinks that it is
another manifestation of EGC. We do not want to give him steroids
(because of his past immune system suppression problems and ringworm).
Given that he doesn't seem affected by the swollen lip in any way (he continues to have a healthy
appetite and eat with ease), is there any problem in not giving him any
treatment? That is, could he be harmed if he does not receive treatment?
Will it ever go away by itself? If so, how long does it usually take to run its course?
Should I expect it to always reoccur? (I should note that he is otherwise a
tremendously healthy, happy, playful indoor cat.)
Many many thanks for any advice you can give.R.R.
Answer: R.R.-
While this condition is very very likely to actually be eosinophilic
granuloma complex, it might be worthwhile to have another biopsy examined
and to make certain that the pathologist who examines it is good at
dermatopathology (examination of skin lesions). Just in case there is
something else that can be identified and treated. Ringworm does sometimes
get misdiagnosed as eosinophilic granuloma complex, because they produce
similar skin lesions, sometimes. So checking another ringworm culture isn't
a bad idea, either. You and your vet can determine if these suggestions
really seem necessary. It would be especially useful to know if the biopsy
was examined by a dermatopathologist while making this decision.It is OK to ignore minor eosinophilic granuloma lesions that are not
causing any apparent pain or discomfort. You do have to keep a very close
eye on these lesions, though. They can change pretty quickly and if they
are getting worse, treatment may be necessary. Also, be sure to open your
cat's mouth at least once a month and look at the roof of the mouth and
tongue to be sure there are no lesions there. These are spots that
eosinophilic granuloma lesions spread to that are uncomfortable and may not
be noticed without looking for them.It may be possible to use a lower dosage of cortisone but give it directly
into the area of the eosiniphilic sores using triamcinilone (Vetalog Rx).
This works well for some cats. Also, it is safer, when it works, to use
oral prednisone. Our experience has been that it doesn't work as well to
use oral corticosteroids in a lot of cats but it is worth a try if
corticosteroid treatment does become necessary.You have doing the right things controlling fleas and staying away from
plastic food bowls. If there is anything else that might induce allergies
that your cat likes to rub its face on, such as a wool blanket, consider
removing it from the environment for a few weeks, too. Flea allergy can
cause eosinophilic granuloma lesions so keep up good flea control even if
you are not seeing fleas.Lots of times eosinophilic lesions clear up on their own for a while.
Usually they do return, although not always in exactly the same place.
Other times, they won't go away without treatment. They seem to vary in how
much they bother the cat, too. The ones that aren't causing problems
probably are safe to take a "wait and see" approach to. Ones that are
causing pain or discomfort should probably be treated.Hope this helps some.
Mike Richards, DVM
12/8/99
Eosinophilic granuloma complex
Q: My question is about my Siamese cat, Mrs. Ming. Many years ago she was diagnosed with eosinophilic granuloma complex. She was at first put on prednisone on a prn basis. Eventually, she was on a qod dose of 5mg. About a year or so ago, megestrol acetate was added to the prednisone. This did wonders at first but now her lip
continues to be large-at best it is not red. My doctor tells me that this is the best we
can do now. I cannot afford the suggested radiation therapy and fear that surgery will put her through so much pain. She does not seem to suffer at present. She eats very well and goes about her business as she always has. I know that time will eventually run out. Do you have any suggestions? If it helps, plaques and rodent ulcer has been used in
her diagnosis. Any help would be greatly appreciated.Thank you! Lana
A: Lana-
At the present time the prevailing opinion among veterinary dermatologists appears to be that eosinophilic granuloma complex is usually a reaction to allergic stimulus in the cat. This has changed the approach taken to this disorder by many veterinarians.
Food allergies appear to cause a higher percentage of allergic reactions in cats than in dogs, although I am not sure this has been confirmed. In any case, testing for food allergy should be considered in a cat with any chronic allergic signs including miliary dermatitis (small scabs in clusters, esp. around the neck) and eosinophilic granuloma complex. To test for food allergies it is necessary to feed a single protein source that the cat has not eaten previously. There are number of hypoallergenic diets on the
market at the current time and it is also possible to choose a protein source such as lamb, rabbit, venison or other meats that are not commonly found in cat food and feed it to the cat for 8 weeks. It is usually possible to feed an all meat diet to a cat for this long without causing nutritional imbalances.
If the condition responds well to the diet then a food allergy is very likely. In that case a more complete diet has to be worked out, using ingredients that do not cause allergic reactions.Inhalant allergies also occur in cats. At present the best way to test for these conditions is intradermal skin testing. It is often necessary to go to a dermatology specialist to get this sort of testing done but that is a good thing to do in a chronic non-responsive skin disease situation anyway. If an allergy can be identified it is possible to use hyposensitization shots in cats or to adjust the medications towards resolving an underlying allergy problem. This can be a good change for a cat that is on prednisone
and megestrol acetate (Ovaban Rx) because many cats will respond to antihistamines combined with omega fatty acid supplementation as an alternative therapy.Skin biopsy can also be a useful test. Once in a while the problem isn't an eosinophilic granuloma even though it looks like one. It is sometimes possible to identify the underlying cause with skin biopsy and it can support a diagnosis of allergic skin disease in some cases as well.
Contact allergies can occur. Plastic food bowls have been incriminated as a contact allergen that causes problems in some cats. Contact allergies can also occur to natural fibers such as wool or even to some dyes in synthetic fibers.
Mosquito bite and flea allergies are also possible causes of eosinophilic ulcers. Eliminating fleas with the use of the new monthly flea control products or oral or injectable lufenuron (Program Rx) can be very helpful. Keeping a cat indoors when mosquitos are most prevalent can be useful. Dawn and dusk are the worst times for mosquitos.
Sometimes it is not possible to identify an underlying allergic cause. In these cases it is still reasonable to try the antihistamine/omega fatty acid supplementation combination. Many antihistamines have been tried but chlorpheniramine, centerizine (Zyertec Rx) and clemastine fumarate (Tavist TM) are often recommended. There are many fatty acid supplements as well. DermCaps (TM) and EFA-Z (TM) are two that I can remember the names of. In addition, there have been reports of successful
resolution of eosinophilic granulomas with chlorambucil (Leukeran Rx) and gold salt therapy. I think that gold salts have to be considered as a last resort because they seem to have a higher chance for toxic effects based on the literature. I can help with doses for these medications if your vet has a hard time finding them.When all of this doesn't work, some vets recommend radiation therapy, but I don't have any idea how well it works. Surgery has been tried by many veterinarians and doesn't seem to work very well.
I have seen recommendations for accupuncture in the treatment of this condition as well but again do not know of literature support for this and have no personal experience.Hope this helps.
Mike Richards, DVM
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