From:
"Tressie"
Date: 2009-03-13 22:55:17 UTC
Subject: [ferrethealth] Re: Suppurative hepatitis -update
To: ferrethealth@yahoogroups.com
An update on Linguini who had a tentative diagnosis of suppurative hepatitis caused by a bacterial agent. Of note, I re-read the pathology report from when she was first diagnosed with EGE in August 2007 and the report also stated that she had mild portal hepatitis with focal suppurative hepatitis. In addition the pathologist wrote: "... the focal area of suppurative hepatitis is an unusual lesion. This lesion is most commonly assoicated with bacterial showering, often from the gastrointenstinal tract. Because of this, we wonder if there is concurrent bacterial enteritis, and it may be a good idea to perform a fecal culture if you have not already done so." Helicobacter was not found in either the stomach or intestinal samples.
At the time we did several fecal cultures and nothing ever showed up so she was never treated for this. Obviously it was an insidious time bomb ticking away all this time. Lesson in this, she probably should have been treated even though the fecal cultures didn't show anything.
The good news is that Linguini had her ALT and PCV checked yesterday after being on the antibiotic combo (Baytril and Amoxicillin) for a week and the antibiotics are working! Her ALT is down to 646 and Hematocrit is now normal at 52%.
She's had a rougher time adjusting to the reduction in prednisolone so we've slowed it down because she was having days when she could barely walk.
We weren't sure if it was due to the disease process (neoplasia was still on the table as a differential diagnosis); or due to cutting back on the pred. The blood results confirmed it is reducing the pred that's been the problem because her values have improved significantly as a result of the antibiotics.
She is scheduled to be switched to Imuran from pred after being on the antiobiotics for 2 weeks and when the prednisolone is down to a minimum dose of 0.05mL/BID. The Imuran (Azathioprine) will be to better manage the EGE.
She will have blood work after being on it for 2 weeks to monitor bone marrow suppression (a possible side effect) and if doing well, will continue on it with regular blood work done every 6 weeks to monitor bone marrow.
Tressie
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