Brain inflammation and possibly lymphoma

whc216

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Hello all,

About a month ago, my cat's behavior suddenly changed. He made hunch over position more often, lowered his neck, circling...I went to the first vet after a week, did blood work and from there, we found elevated ALT (359), bit higher side on AST and lower side of CHOL.Doctor gave me some medication to try out: to bring liver level down. After a week, my cat's symptom was not getting better, but worse, thought his symptom was more like vestibular disease, so I ended up going to another vet. In there, the doctor saw him circling, head tilt and all that, gave me medication (Prednisolone and Orbax) and recommended me to go to Neurologist.

Moving forward (2 weeks after the vet's visit), yesterday, after constantly asked my primary car for referral, I was able to go to Neurologist and had MRI scanned for my cat's brain. The result was something I was not expected. Doctor told me he has severe brain inflammation (encephalitis). They were not able to find masses showing in MRI image, but given how severe and medication did not work much past 13 days (I gave Orbax (0.9ml) and Prednisolone (5mg) once a day), the doctor is leaning toward Lymphoma or FIP, with slight chance of other inflammation diseases.

I am devastated and also not sure what to do after. The doctor recommended me check another doctor for ultrasound to see if it is FIP. To be honest, I am a little bit frustrated because one doctor asks for another additional test, which given holiday season, I have to wait and it just keeps circling. Then if not, I may have to check if it is Lymphoma (not sure what test to do because I did not get much instruction on that). From his severe brain inflammation and slow response to medication, the doctor was leaning either FIP or Lymphoma, but would other can cause brain inflammation can come from other? Also I understand Predisolone but not sure if Orbax is a proper medication for my situation? Is there any case medication may work slowly? It has been 13 days since I gave orbax + predisolone and I felt like I saw him slightly getting better past 3 days (but I can be wrong too...)

Sorry about long message. I just wanted to give some context of my situation. Any cat parents had this experience, could you share and also help me on this?

To add: My cat's appetite may decreased slightly because he isn't interested in treats, but he also eats his breakfast & dinner fine and still attempts to steal other cats' food after. I saw him drinking more water than usual, but he still moves around, goes to the litter box and did not see anything off.
 

fionasmom

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I am going to put some articles here for you to look at. They are very broad ranging though as it seems that you have been given a very general diagnosis and have not been given strong direction from any of the vets, although they are doing their job professionally. I can understand that in dealing with specialists their limit of diagnosis is usually limited to their specialty. That is probably the reason that the neurologist told you to go to another vet for the US to determine FIP or not. Frustrating, because you would hope or think that if the FIP is causing the inflammation and the inflammation is in the brain that the neurologist could continue on from there.

As I understand this, you have been told that your cat might have lymphoma or FIP; however, you also wondered about other causes of brain inflammation. If it is lymphoma, do they suspect renal lymphoma which spread to the central nervous system? No masses were seen on the MRI in the brain, so back to inflammation?.

How to Treat Encephalitis in Cats
Meningitis in Cats
Brain Inflammation in Cats | PetMD
Lymphoma in Cats - Mar Vista Animal Medical Center
 
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whc216

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I am going to put some articles here for you to look at. They are very broad ranging though as it seems that you have been given a very general diagnosis and have not been given strong direction from any of the vets, although they are doing their job professionally. I can understand that in dealing with specialists their limit of diagnosis is usually limited to their specialty. That is probably the reason that the neurologist told you to go to another vet for the US to determine FIP or not. Frustrating, because you would hope or think that if the FIP is causing the inflammation and the inflammation is in the brain that the neurologist could continue on from there.

As I understand this, you have been told that your cat might have lymphoma or FIP; however, you also wondered about other causes of brain inflammation. If it is lymphoma, do they suspect renal lymphoma which spread to the central nervous system? No masses were seen on the MRI in the brain, so back to inflammation?.

How to Treat Encephalitis in Cats
Meningitis in Cats
Brain Inflammation in Cats | PetMD
Lymphoma in Cats - Mar Vista Animal Medical Center
Thank you for the reply!
No masses were see on the MRI and due to severity of swelling and herniation, the doctor was leaning lymphoma or FIP, but we did not actually do biopsy or any for lymphoma. And I meant brain lymphoma. So yes, for now, steroid to reduce inflammation but recommend to see more specialist. But I also want to see if this can be from others as links suggested.
 

fionasmom

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Please keep us posted. I am sorry that you are facing such a complicated problem with your poor cat.
 

mrsgreenjeens

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Gosh, this is a little surprising after having read your other thread. I would never have thought either of those two diagnosis, but we still really don't know if they are accurate or not. I'm really surprised that the neurologist didn't do the test for FIP, since I would think it would be up to him to do the following (from icatcare.org):

-Evaluation of a cerebrospinal fluid sample (the fluid that surround the brain and spinal cord) in cases where there are neurological signs

I wouldn't think anyone but an animal neurologist would be able to do the above sample. Actually, I've never heard of diagnosing FIP from an ultrasound either. What other specialist did they refer you to next? Not sure I understand why an ultrasound would be needed when you already have an MRI. I always thought MRI's showed more info than an ultrasound, but could be wrong (probably am).

Initially, I know they ran blood work since he had raised liver values. Those can be a sign of FIP, but can also be a sign of several other things, so I wouldn't be quick to jump on the FIP wagon. If the liver values were the only things out of whack, I really wouldn't rush to think that's what it is. But on the other hand, I would think of it were brain lymphoma, there would be a tumor there, and the neurologist didn't see one, right? So I'm kind of baffled here.

I would have a chat again with your regular Vet who could possibly chat with the neuro doc and find out WHY they think you need an ultrasound after an MRI (unless you actually understand it) and also ask about other possiblities. There ARE other possiblities, as seen in the articles provided by fionasmom fionasmom . Plus now that you know there is swelling, maybe your regular Vet can at least prescribe something to help with that while you are working on what is causing it.
 
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whc216

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Gosh, this is a little surprising after having read your other thread. I would never have thought either of those two diagnosis, but we still really don't know if they are accurate or not. I'm really surprised that the neurologist didn't do the test for FIP, since I would think it would be up to him to do the following (from icatcare.org):

-Evaluation of a cerebrospinal fluid sample (the fluid that surround the brain and spinal cord) in cases where there are neurological signs

I wouldn't think anyone but an animal neurologist would be able to do the above sample. Actually, I've never heard of diagnosing FIP from an ultrasound either. What other specialist did they refer you to next? Not sure I understand why an ultrasound would be needed when you already have an MRI. I always thought MRI's showed more info than an ultrasound, but could be wrong (probably am).

Initially, I know they ran blood work since he had raised liver values. Those can be a sign of FIP, but can also be a sign of several other things, so I wouldn't be quick to jump on the FIP wagon. If the liver values were the only things out of whack, I really wouldn't rush to think that's what it is. But on the other hand, I would think of it were brain lymphoma, there would be a tumor there, and the neurologist didn't see one, right? So I'm kind of baffled here.

I would have a chat again with your regular Vet who could possibly chat with the neuro doc and find out WHY they think you need an ultrasound after an MRI (unless you actually understand it) and also ask about other possiblities. There ARE other possiblities, as seen in the articles provided by fionasmom fionasmom . Plus now that you know there is swelling, maybe your regular Vet can at least prescribe something to help with that while you are working on what is causing it.
Thank you for the reply.

I just re-read what the doctor said and I misunderstood ultrasound. It's about to see if there is inflammation or cancer in other organs. We did serology 2 (to see if it is toxo or crypto?) and FIP test and the result will come back in few days. Regarding the brain lymphoma, what they said was it could be in the brain that they cannot see from the image.

To be honest, I am still lost and unsure where to go from here. Yesterday, he was so much better, but that was because of increased steroid. I am hoping it is somewhat immune related that he got because my other cats (from same family), they all have different variant of immune, like one always gets skin issue from pollen and another has epilepsey...
 

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Hopefully the results in a few days will tell you something helpful.
 

mrsgreenjeens

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Thank you for the reply.

I just re-read what the doctor said and I misunderstood ultrasound. It's about to see if there is inflammation or cancer in other organs. We did serology 2 (to see if it is toxo or crypto?) and FIP test and the result will come back in few days. Regarding the brain lymphoma, what they said was it could be in the brain that they cannot see from the image.

To be honest, I am still lost and unsure where to go from here. Yesterday, he was so much better, but that was because of increased steroid. I am hoping it is somewhat immune related that he got because my other cats (from same family), they all have different variant of immune, like one always gets skin issue from pollen and another has epilepsey...
Did they refer you to another specialist, or just to go back to your regular Vet for the ultrasound, or first wait for the results of the tests they ran? And I would certainly think an increase in the steroid would make him feel better as it should help with the inflammation. If he's acting like he feels better, then it's probably ok to at least wait for the test results before taking any further steps, unless they recommended you do something else immediately. Once you get the test results, you might give your regular Vet a jingle and discuss everything with them. I assume (shame on me) that the neurologist will be forwarding all office notes and test results to them since it was a referral.
 
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whc216

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Did they refer you to another specialist, or just to go back to your regular Vet for the ultrasound, or first wait for the results of the tests they ran? And I would certainly think an increase in the steroid would make him feel better as it should help with the inflammation. If he's acting like he feels better, then it's probably ok to at least wait for the test results before taking any further steps, unless they recommended you do something else immediately. Once you get the test results, you might give your regular Vet a jingle and discuss everything with them. I assume (shame on me) that the neurologist will be forwarding all office notes and test results to them since it was a referral.
So we're back to the original point...We dud Feline Serology for diseases/infections like Toxoplasmosis and Crypto, and ELISA test for FIP. Actually, before I got this result, his elevated liver like ALT and AST and brain inflammation thought it could perhaps FIP, but that ELISA test shows negative. At this point, since image doesn't show any masses, but ELISA said negative, neurologist says lymphoma. But I did some search about lymphoma, and I did not find much information about brain, but others like kidney, or intestinal. I don't think his (low end) blood panel shows anything much elevated other than kidney, so I am baffled...

For whatever reason, CSF can be happened (neurologist supposed to ask me), but she was ruling either lymphoma or FIP (which ELISA has used) from inflammation...

At this point, how reliable ELISA negative means? It's negative so my cat has no chance this is from FIP? I am just so lost and unsure where to go from here.
 
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fionasmom

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Any test can have a false positive or negative and I don't know what the margin of error might be on that specific test. Your vet could probably tell you if this is a cause for concern. Are you going to do the US?
 

mrsgreenjeens

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Any test can have a false positive or negative and I don't know what the margin of error might be on that specific test. Your vet could probably tell you if this is a cause for concern. Are you going to do the US?
I agree that you should discuss all this with your regular Vet. How is your little guy doing today? Is the increased steroid still making him feel better?
 
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whc216

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Any test can have a false positive or negative and I don't know what the margin of error might be on that specific test. Your vet could probably tell you if this is a cause for concern. Are you going to do the US?
What is US?

I agree that you should discuss all this with your regular Vet. How is your little guy doing today? Is the increased steroid still making him feel better?
I did not increased steroid yet. I actually went to another vet specialized in GS stuff and got some feedback that we may try 1 week of GS treatment to see where it goes, while I try to schedule oncologist as well :(
 

mrsgreenjeens

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My error on the steroid. Well keep us posted on what's next and how he's doing please.
 
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whc216

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My error on the steroid. Well keep us posted on what's next and how he's doing please.
Thank you. The vet I saw yesterday was debating between increasing steroid or not, but for now, decide to keep the same due to GS trial.

US is ultrasound. I hope that things might be improving a little.
No, I don't think I will do US at this moment. Bringing him to another place for testing seems too much stress for him, and I think I got most of test I needed.
 
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