Unidentifiable lesions on hind leg, anyone seen something similar?

[stoorworm]

Hello everyone,
I’m writing this on behalf of a friend of mine in Sri Lanka. We met on an FIP group while she was suspecting her kitty was suffering from it but it seems like it’s a different illness altogether.
Her kitty Cooper has been feeling unwell since October 2020 along with developing lesions on his hind leg.
She’s went to numerous vets in her country and no one can find what’s wrong with him. She’s started consulting with doctors from the US and Australia via email to no avail...

Has anyone seen lesions like this?
Coop also had anemia and elevated ALT and TP to start with. The liver enzymes went down with prednisolone and spiked with drugs that cause hepatotoxicity. The high TP is persistent.
I’ve looked into similar lesions and what I found that came along with matching symptoms were osteosarcoma and cutaneous lymphoma.
But her vet said the lesion wasn’t cancerous after a biopsy. For what it’s worth, the Australian doctor doesn’t trust the biopsy result.
He also wants to look into leishmania.
Coop’s blood test results are all over the place so there’s a high possibility he has a couple of things going on all at once.
One vet also suspected cholangitis and I’m looking into cholangiohepatitis that was probably aggravated by drug hepatotoxicity.

Has anyone seen similar lesions? Any idea what they could be?
They react well and decrease in size with topical steroid creams.
Coop is also on a constant med cocktail, including steroids.
Sorry about the gory images.

 

[Antonio65]

Hi S stoorworm , what a sad sad story you're telling us, I'm so sorry to see that poor cat in that condition
Are you able to post the blood results as well? They could be helpful to spot something.
I, too, think that the biopsy should be repeated, possibly at a different lab.
Have they suspected any possible case of eosinophilic granuloma?

 

[stoorworm]

Hi S stoorworm , what a sad sad story you're telling us, I'm so sorry to see that poor cat in that condition
Are you able to post the blood results as well? They could be helpful to spot something.
I, too, think that the biopsy should be repeated, possibly at a different lab.
Have they suspected any possible case of eosinophilic granuloma?

Thank you! Will let them know to look into that too. Honestly I’m quite angry at how they’ve been handling Coop’s situation. They haven’t even done an xray on the leg to see if there’s any anomaly in the bone even though he had a sudden NA spike which could very well mean bone degeneration... She’s talking with a new vet now, hopefully there’ll be some progress.

Sorry!! I also had an excel sheet of Coop’s meds and blood test results that I forgot to post! It’s very lenghty... Poor thing has been fighting for a while.

 

[Antonio65]

From what I'm reading, Cooper has had a regenerative anemia at the end f the past year. His RBC count was low, but his Reticulocytes were high, so he was regenerating the red cells, and it shows in the most recent values that are higher, but no that much.
No sign of cholangitis, since the last test is Feb is alright, but there was a sign of it last year, along with the liver damage which is still evident.
Albumin and Globulin are high, as far as I know this could be a symptom of a chronic infection, as revealed by the high count in WBC.
It would be interesting to have a test revealing the number of eosinophilic cells, that might confirm my suspect of a granuloma.
Poor little angel, he's been through hell so far.

 

[stoorworm]

Antonio65 Thank you so much! You’re really giving them something to look for that wasn’t thought of until now!
Got her to send me his 19/04/2021 and 01/05/2021 results too.
WBC seems to have decreased significantly though... It’s honestly all over the place.

She says Coop’s been on Cephalexin, 5mg pred, esempresol and cobalamin supplements before the May 1st blood test.
She’s using sonaderm-gm topical anti inflammatory cream and this is the latest photo of his lesion. It’s responding well but the steroid is probably just masking the main problem.

 

[Antonio65]

I can see the eosiniphilis are in the range, this seems to rule out my main suspect.
I hope to be totally wrong with my diagnosis, after all I'm no vet, but that Calcium that high is a bad signal... If I were your friend, I would have a new biopsy of the lesion done as soon as possible.
I still hope is "just" a granuloma.

 

[stoorworm]

The high calcium signaling bone degeneration is what I’m scared of... But I’m hoping it has another explanation. I’ve spent hours staring at the bloodwork and researching med side effects and toxicities to make it make sense...
Will definitely advise another biopsy asap. I really hope it’s an obscure combination of treatable things and not something major effecting his whole body.
Thank you so much for your help! Will keep posting here if anything new comes up.

 

[Antonio65]

Other than bone degeneration, a high calcium in the blood might be a signal of cancer anywhere in the body. That's why my advice is to have a second biopsy of the lesion done.
As for the liver disease, your friend shoudl investigate whether Cooper has eaten something harmful or if his diet is right for him, though I think your friend has already taken care of this, she sounds like a very careful mom to him.
Fingers crossed here.

 

[Jesse James]

Is it a fungus? I'm attaching part of an article from Cornell Veterinary College on skin disorders in cats. If you go to their site you may be able to obtain more ideas on this subject.

 

[LTS3]

She’s went to numerous vets in her country and no one can find what’s wrong with him. She’s started consulting with doctors from the US and Australia via email to no avail...

Your friend needs to have her vet email and consult with other vets. Many veterinary schools offer courtesy consults to vets only. Your friend can also have her vet contact this US vet hospital for a consult: Referral Services • MSPCA-Angell

Vets won't / can't offer any help from a random email from a non-client.

 

[stoorworm]

Jesse James Thank you for your reply. Unfortunately it’s not a fungal infection. They were ruled out.

LTS3 I’ll let her know, thank you.

Antonio65 Thank you. The liver problems were thought to be due to the drugs he’s on but his initial values weren’t all that good either...

She’s contacting veterinary faculties right now. Her vet said they couldn’t perform needle biopsies so if she’s turned down by universities too she’ll have them perform a biopsy on the lesion for a tissue sample and send it to a human lab for further analysis.