Sage ClinicalSummary AN268826 S10460

CLINICAL SUMMARY
Ph Animal No.
Email
Client Details Patient Details

Name Grant, Sylvaine & Adam Phone (917) 587-0199 Name Jasper Age 7 months
Address 5437 Green Side Dr (917) 683-1362 Species Feline (Cat) Sex Male
San Jose, CA, 95127 Breed Bengal Referral Dr Rubin, Shira - Curtner
Pet Clinic
Health Status
Date/Time Weight (kg) Temp(°F) Heart Rate Respiratory Rate Attitude Notes
01-22-2018 2:00:00pm 104.0 190 28 QAR
01-22-2018 10:00:00am 104.0 195 28 BAR
01-22-2018 6:00:00am 3.30 104.3 190 30 BAR CRT = 1sec
01-22-2018 2:00:00am 104.0 200 30 QAR CRT = 1
01-21-2018 10:00:00pm 104.2 120 35 QAR
01-21-2018 6:00:00pm 103.3 130 30 QAR Weight = 3.3kg
01-21-2018 2:00:00pm 106.2 28 QAR Pulse = unable MM = Lt pink
01-21-2018 10:00:00am 103.5 190 24 QAR
01-21-2018 6:00:00am 3.33 104.3 190 50 QAR CRT = 1sec
01-21-2018 2:00:00am 103.7 200 30 Attitude = Depressed CRT = 1sec
01-20-2018 10:00:00pm 102.4 210 50 QAR Attitude = Obtunded
01-20-2018 6:38:09pm 3.36 104.1 180 48 QAR
01-20-2018 6:00:00pm 3.36 104.1 180 48 QAR
10-11-2017 9:08:01am 1.85 102.4 170 40 BAR ear temp.
10-10-2017 12:48:41am 1.76
10-06-2017 7:07:11pm 101.9
10-05-2017 7:52:02am 1.76 103.1 Pulse: Purr Respiration: Vocal Weight:
1.760 kg, 3.87 lb, 0.15 m2
10-04-2017 8:16:22am 1.80 103.9 190 Respiration: Pant Weight: 1.800 kg, 3.96
lb, 0.15 m2
10-03-2017 7:46:58pm 1.70 105.8 210 40 Weight: 1.700 kg, 3.74 lb, 0.14 m2
Presenting Problem(s)
Recheck
Has A Temperature
Refill Medication
Other Test
Recheck in 1 week. 1/23/18 603p DJD,ca
Hi temp. allisons/ca
Pdvm recs
RG pt- mom requested refill of Metronidazole. mom only has 1 dose left. mom also asked how long p should be taking rx? Please call
mom once ready at 917-587-0199, alexisw/CA
O called to request a drop off appt for add'l testing, o has to work and is only avail early morning. Fasting adv GenistaD 10/10
dc 10/6 @ 08:06 Sylvaine called to inquire a good time to bring pt in to do a wt check. Please call cell to discuss. GenistaD think meant
temp not weight. Diana C.
(917) 587-0199 (Primary)
Patient Name: Jasper
Client Name: Grant, Sylvaine
RM 14
(917) 587-0199 (Primary)
(917) 683-1362 (Secondary)
Patient Name: Jasper
Client Name: Grant, Sylvaine
History
Jasper, a 7 MO MI Bengal, was presented to the SAGE IM service for workup of pyrexia and hyperglobulinemia.
Owner reports 1-2 month history of lethargy and decreased ability to run/jump and was painful upon picking up. Waning appetite over
the last 4-5 days, no V/D/C/S, indoor only, one other cat at home.
Worked up for chronic diarrhea in 10/2017. FeCOV fecal PCR positive multiple occasions. Diarrhea responded to
Clavamox/metronidazole/enrofloxacin.
pDVM notes:
1/16/18: T: 104.4, pain upon picking up. Rx Clavamox, LRS 120 ml sq. Rad review 9Rivers): Decreased pulmonary vasculature,
Remaider of thorax WNL. HCT: 24.3%, microcytic, normochromic. 15k retics, WBC: 25.6k, Neuts: 12.288, Lymph: 11.7k, Mono: 768. Plt:
311. Chem: Glu: 64, Creat: 1.0, BUN: 23, Phos: 7.3, Ca: 9.4, Alb: 2.5, Glob: 6,4, CK: 38. Remaining values WNL. tT4: 1.6. FeLV/FIV
neg/neg.
1/19/18: T: 103.0, Rx Liquitinic, Nutrical, Onsior. UA: Free catch: USG: 1.043, 0 prot/glu/ket, 2+ blood. 0-2 WBC.
UPDATE:
persistently febrile, eating, FNA of hepatosplenomegaly and mesenteric LN performed; pending Owner elects discharge.
Jasper was presented for fever and further workup of possible FIP.
No records available and pDVM is not currently open - Saturday night exam.
Jasper was worked up at SAGE in 10/2017 for fever and was suspected to have FIP at the time. He had mild ascites, a hyperglobulinemia
(resolved on SAGE bloodwork), high coronavirus titer, and PCV positive coronavirus in the stool. He responded well to a few days of
hospitalization and was discharged.
After discharge, owners report that he did much better and was a lot stronger. Diarrhea resolved and he had a good appetite.
Over the past 1-2 months, he has been playing less and sleeping a lot more. He cannot keep up with the other kitten. His appetite has
remained good, but has declined over the past few days. For the past 5 days, he has gotten weaker and more wobbly. 4d ago he
developed at fever of 104
Owners report he went to the vet a few days ago and had diagnostics done
WB rads were normal per O

Bloodwork was performed - owners had a few numbers written down from notes from pDVM conversation. WBC 35k, Glob 6.4,
PCV 24%
UA was submitted and is pendig
Primary Problem: P brought in for high temperature and inappetence. O states P was transferred from pdvm for possible ultrasound. O
states P had x-rays done and no signs of organ issues or fluid in lungs. O states P is painful on chest and had blood work done as well. O
states P is syringe fed 5mLs of water every hour and is not eating as much. O states P was given SQ fluids twice at pdvm when P fever
was not declining. O states P is also anemic.
When did it start?: few days ago
Has pet been treated at another veterinary clinic for this illness?: Yes
Any Coughing?: No
Any Sneezing?: No
Any Vomiting?: No
Any Diarrhea?: No
Water Consumption: Decreased
Urination Frequency: No Change
Any chance for exposure to toxins?: No
Any known dietary indiscretion or eating something they shouldn't?: No
Does your pet have a sensitive stomach?: No
Has your pet Ingested any raw fish?: No
Current Medications: Clavamox given BID, last dose given before arriving here and iron supplement SID
Diet: dry and wet cat food
Allergies: none
History: O states per pdvm no sign of infection anywhere
Today's weight was 1.85 kg (1.72 kg 1.8 kg).
Jasper, a 5 MO MI Bengal, was rechecked by the SAGE IM service today for further work up of diarrhea and fever.
Owner adopted from breeder in Sacramento 2 months ago. Diarrhea (2-3 BM/day, occasional urgency/tenesmus) noted since adoption.
Seen at Alum Rock for pyrexia (records not availble) ,treated with metronidazole, fever resolved in three days, diarrhea never
substantially improved.
Seen multiple times at Curtner AH for diarrhea (Previously febrile) for diarrhea. Fecal PCR positive for FeCoV, negative for all others.
Empiric deworming, metronidazole.
Hospitalized at SAGE from 10/ 3-10/5/17. Febrile, chronic diarrhea. High globs IH. Elevated FeCoV titer (>1:12600) scant FF on abd u/s,
coarse liver, fecal PCR again positive. Discharged on antibiotics, prednisolone (not started). Suspected FIP.
UPDATE:
Since discharge, eating well, BAR. Still having watery brown diarrhea at home. No C/S/V, good energy, occasional shaking/trembling.
Tolerating medications well.
Current Medications:
1. Metronidazole susp 50mg/mL: 0.4mL PO BID

2. Clavamox susp. 62.5mg/mL: 0.5mL PO BID
3. Marbofloxacin 25mg tablet: 1/4 tab PO SID
Diet: Veluva mostly, variety of wet food, added pumpkin

Allergies: none
History:
Pt is doing better, but still shakes sometimes. Temp Sun was 101.5. Appetite very good, playing a lot. Feeding 4 meals a day. No
coughing/sneezing/vomiting/regurgitation. Owner saw pt drinking water once, urination normal. Stool is still diarrhea.
Owner has concern for other kitten (keeping separate) - seeing diarrhea with red flecks. DEL
Jasper is a 4m old Bengal presenting for persistant worsening diarrhea since adopted.
rDVM testing (see medical records) with no identifiable cause.
Chronic black tarry discharge from both ears - neg for mites - no medications.
Metronidazole course with no effect per owner, not currently on medications.
No hx of pica. Vaccines from breeder - usure if up to date.
Occasional clicking noise from mouth when chewing.
No vomiting, appetite normal.
Very lethargic today. Littermate's normal (aquired from breeder)
Current Medications:
NONE
Diet: RIVUTA WET AND SCI DRY KITTEN FOOD
Allergies: none
Past Pertinent History
Persistant diarrhea and lethargy
Jasper presents to sage for diaherra that has never stopped since O's adopted in aug, P had been treated for deworming and other gi
issues but P isnt get any better and still having D+ all over O's house -kmca
Physical Exam
Neurologic examination findings:

Mentation: Normal
Posture: Normal
Gait: No ataxia, paresis, nor lameness noted
Proprioception: Intact all limbs
Cranial Nerves: All normal
Spinal Reflexes: withdrawals intact all limbs
Palpation: consistently reacts to lumbar spinal palpation with vocalization and attempts to move away from restratint
Neuroanatomic localization: T3-S3
If the pending diagnostics do not provide a diagnosis, MRI +/- CSF tap could be considered.
GA: QAR/meowing. Ambulatory x4. hydrated based on skin turgor and tear film. BCS: 4/9, MSS: 2/3.
CV No murmur, Regular rhythm, Femoral pulses strong/synchronous/symmetric bilaterally, CRT: 1.5 sec, MM: Pink, moist. No jugular
pulses appreciated.
Resp - auscults clear, no crackles/ wheezes ausculted, No cough on tracheal palpation. Lung
sounds appreciated in all lung fields. No laryngeal stertor or stridor.
GI/ GU - soft, nonpainful. Liver not palpable beyond costal margins. Spleen not palpable. Kidneys palpate ~3.5 cm,
soft/smooth/nonpainful. Urinary bladder <2 cm, soft, smooth, nonpainful. Rectal not performed.
Integ: Shaved cephalics and abdomen, IVC in cephalic. Otherwise full clean coat,
No masses No ectoparasites, no comedones, alopecia nor petechiations/ecchymoses.
EENT - Clear corneas OU, sclerae white. Smooth corneal surface, no blepharitis, corneal neovascularization, no discharge OU with intact
PLRs D&C intact OU. Undilated fundic: No chorioretinal lesions, no retinal separation, no retinal hemorrhage, central cataractous
changes absent OU. Ears normal/ normal odor, no nasal discharge. Oral: No dental calculus, juvenile dentition, no masses, no obvious
draining wounds/tracts appreciated, no foreign material under the tongue. Pharyngeal palpation WNL. Cervical palpation is WNL. No
palpable thyroid slip
M/S - no lameness, ambulatory x4, no lameness nor joint pain appreciated. No joint effusion nor pain/heat appreciated. No obvious long
bone pain appreciated.
Neuro CN intact, no positional nystagmus nor strabismus, ambulatory x4, Lumbar pain on vertebral palpation, no ataxia noted. PP intact
x4.
PLNs - Mandibular, superficial cervical and popliteal LNs soft, 0.67 cm no other palpable PLN appreciated.
pain - no abdominal pain appreciated as above, no other focus of pain appreciated.
1700h: QAR, standing at cage front. MM: Pale pink, eupneic.
BAR, nervous kitty.

EENT: MM pink and moist, CRT < 2sec. Eyes clear OU, tear film adequate. No ocular/nasal discharge. Oral exam unremarkable, no
masses or ulcers seen, nothing under tongue.
CV: no murmur/arrhythmia, femoral pulses strong and synchronous
Resp: eupneic, clear auscultation with no crackles or wheezes, no stridor/stertor
GI/GU: non painful, no obvious distension/masses/organomegaly
MS/NS: BCS 5/9 appropriate mentation and ambulation
Integ: NSF
LN: NSF
GA: BAR/meowing. Ambulatory x4. hydrated based on skin turgor and tear film. BCS: 4/9, MSS: 2/3.
pulses appreciated.
soft/smooth/nonpainful. Urinary bladder <2 cm, soft, smooth, nonpainful. Rectal: soft light brown feces on thermometer sleeve
Integ: .Shaved cephalics and abdomen, otherwise full clean coat,
changes absent OU. Ears normal/ normal odor, no nasal discharge. Oral: No dental calculus, juvenile dentition, no masses, no obvious
Neuro CN intact, no positional nystagmus nor strabismus, reflexes intact x4, ambulatory x4, no vertebral pain appreciated, no ataxia
noted. PP intact x4.
Appearance: Quiet alert responsive and 5-6% dehydrated, lethargic

Body Condition Score = 5/9
Eyes: No evidence of pain, discharge, anisocoria. Appears visual without cloudiness in either eye.
Ears: No gross aural discharge or odor. No pain on palpation.
Nose/Oral Cavity: No evidence of nasal discharge, foreign body or sneezing. Oral cavity free from foreign material. No ptyalism.
Lymph Nodes: No evidence of generalized or solitary lymph node enlargement
Respiratory: Eupneic, bronchovesicular sounds heard in all fields.
Cardiovascular: No murmur/arrhythmia/pulse deficits. Pulses strong and synchronous.MM=pink, CRT 1sec
Abdomen: Abdomen soft and nonpainful. No organomegaly or masses appreciated.
Urogenital: Within expected limits
Musculoskeletal: Within expected limits
Neurological: No mentation changes. Reflexes within expected limits
Skin: No evidence of hair loss or ectoparasites.
Rectal: Not performed. Dried feces on anus.
Assessments
Cytology shows:
Liver: Few mixed inflammatory cells with mild mixed hepatocellular vacuolation.
Spleen: Moderate lymphoid reactivity.
Lymph node: Mild to moderate lymphoid reactivity with moderate neutrophilic to pyogranulomatous
inflammation.
Recommend FeCOV ICC on lymph node. If positive, confirms diagnosis, if negative, cannot r/o FIP without biopsy.
Pyrexia: Open. R/O infectious (bacterial, viral, protozoal) vs neoplastic vs immune vs drug. Concern over FIP given history and
organomegaly with hyperglobulinemia. Pend FNA, consider biopsy as indicated. If FIP supported (pyogranulomatous inflammation),
consider prednisolone trial (UCD FIP trials closed at this time). Broaden antbiotics in the interim.
Hepatosplenomegaly with mesenteric lymphadenomegaly: Open. R/O FIP or other infectious vs infiltrative disease (neoplasia). Pend
FNA, consider biopsy to be definitive.
Hyperglobulinemia: Open. R/O chronic inflammation (polyclonal) from monoclonal (neoplastic) causes. Pend workup above, consider
protein electrophoresis.
NNN Anemia: Open. R/O anemia of inflammation vs primary marrow dysfunction. Workup as above, consider marrow if progressive and
diagnosis still open.
Lumbar pain: Open. R/O Secondary to FIP/pyogranulomatous disease vs infiltrative neoplasia vs other. Consider advanced diagnostics
(MRI/CSF) as indicated.
FeCoV+ (fecal/multiple episodes). R/O FeCOV/FIP, suspect patient chronic carriage fo FeCoV. Consider repeat testing, biopsy of organs
above for definitive diagnosis.
1) Fever with hyperglobulinemia and leukocytosis, r/o FIP vs other viral infection (URI, enterocolitis) vs bacterial infection (UTI,
cholangiohepatitis, pneumonia open)
2) Hyperglobulinemia, r/o FIP vs other inflammatory vs neoplastic
Improved signs, diarrhea. Owners to continue novel protein diet, metronidazole (consider calling into Roadrunner) and recheck exam
and stool in 14d (look for ongoing persistence of FeCoV in stool). Consider GI bx vs steroids if signs persistent and persistent FeCoV in
stool.
RSG
Pyrexia: Not noted at this time (borderline) No focus found on interrogation of either cavity. R/O GI based on history. Differentials
bacterial, viral (FIP vs other) vs inflammatory/immune vs neoplastic (less likely). Consider further work up; (consider hepatic FNA, fluid
sampling if available, GI biopsies given diarrhea) if not feasible, consider prednisolone for inflammatory/FIP.
Diarrhea: Open. R/O infectious (bacterial, FIP) vs protozoal (Tritrich, other) vs inflammatory/IBD. No cause elucidated despite multiple
fecals and colonic lavage. Work up as above, consider GI biopsy to be definitive. Consider B12 supplementation, repeat fenbendazole
trial, select protein diet (very atypical for inflammatory intestinal disease at such a young age).
Anemia: Open. R/O age-related vs secondary to inflammation vs loss (preregenerative) vs marrow vs destructive. Historically WNL,
argues for anemia of inflammation though other causes cannot be ruled out. Consider monitoring; static at this time.
Fecal FeCoV+: Proves exposure/infection. Concern for FIP in patient given pyrexia, hyperglobulinemia (unless spurious) and FF. Patient
from suspected house with other cat with FIP. Consider sampling of fluid (abd) if available, GI biopsies as above.
FeCoV PCR positive again in stool. Increases concern for FIP given clinical signs and chronic poassage of FeCoV in the GI tract.
Recommend GI biopsies, if decliend, consider glucocorticoids.
RSG
Chronic large bowel diarrhea - r/o primary GI ( infectious (viral, bacterial, paracitic) vs inflammatory vs neoplasia ) vs secondary
GI ( pancreatitis, metabolic, endocrine, neoplasia)
Febrile - r/o infectious vs inflammatory
Lethargy
Otic debris - r/o infectious vs anatomical
Mild anemia 22%
Mild neutrophila
Plans
FeCoV ICC to LN at VDx.
Plan recheck in one week.
RSG
DIAGNOSTICS:
AUS: Hypoechoic liver, splenomegly, lymphadenopathy, peritoneal effusion (scant): R/O infectious (FIP) vs neoplastic etiologies
Chem: Glob: 6.2, BUN: 15, Creat: 1.3, remaining WNL.
PT/PTT WNL
CBC: HCT: 20.5 Mircrocytic/hyperchromic, nonreg (16.5k) WBC: 28.89k, Neuts: 17.30,k, Lymph: 1040, Plt: 322k. PCV/TS: 28/2.2.
PLAN:
Hospitalize for day
LRS IV 8 ml/hr (maintenance)
Unasyn 30 mg/kg IV q8h
TPR q4h
Owner elects discharge at 1700h
Rx:
Maropitant Citrate 16mg Tablets: PLEASE GIVE 1/2 OF A TABLET BY MOUTH ONCE DAILY FOR NAUSEA. #4 1 REFILL.
Marbofloxacin 25mg Tablets: PLEASE GIVE 1/2 OF A TABLET BY MOUTH ONCE DAILY. #5 1 REFILL.
Fluids LRS Inj Bag 1000mL PLEASE GIVE 75 ML OF FLUID UNDER THE SKIN ONCE DAILY. #1 1 REFILL.
PENDING:
VDX cytology:
Liver
Spleen
LN
Diagnostic plan:
1) iStat iCa 1.33
2) PCV 27%, TS 9.2
3) Brief N/C AFAST- scant free fluid noted in caudal abdomen.
4) AUS tomorrow morning
Treatment plan:
1) Hospitalization for IVF palliation of fluid and to facilitate AUS tomorrow
2) IVC placed
3) LRS 10 ml/kg bolus, then 18 ml/hr
4) Clavamox 62.5 mg/ml - 0.6 ml PO BID (due 7am)
5) Onsior 6mg PO SID (due 7am - HOLD, ASK before giving)
6) Transfer to CW for further workup and care
Consider fenbendazole trial (declined at this time)
Owners attempting novel/select protein diet (Rabbit; OTC)
If persistent diarrhea and biopsies declined, consider prednisolone.
Clavamox 62.5 mg/ml: D/C at this time.
Marbofloxacin 25 mg tablets: D/C at this time.
Metronidazole 50 mg/ml: Please give 0.4 ml orally every 12 hours with food. Stop if balance issues are seen. #5 1 refill.
Metronidazole 50 mg/ml: 0.4 ml PO q12h. Stop if balance issues are seen. #30 1 refill. Roadrunner.
Prednisolone 15 mg/5ml: Please give 0.6 ml orally once daily. Do not start until Oked by Dr. Garcia. #10 1 refill.
Recheck/update in 14d.
Consider repeat FeCoV PCR on stool to look for resolution or persistence (more supportive of FIP).
RSG
PLAN:
Discharge to owner.
Consider fenbendazole trial.
Consider attempting novel/select protein diet.

If persistent diarrhea and biopsies declined, consider prednisolone.
Clavamox 62.5 mg/ml: Please give 0.5 ml orally every 12 hours with food. 1 box, 1 refill
Marbofloxacin 25 mg tablets: Please give 1/4 of a tablet by mouth once daily, ideally with food. #3 1 refill.
Recheck/update in 14d.
Consider repeat FeCoV PCR on stool to look for resolution or persistence (more supportive of FIP).
Send home novel protein diet (owner is unlikely to feed).
hosp
LRS 8ml/hr
Maropitant 1mg/kg IV q24
Metronidazole 10mg/kg IV q12
Marbofloxacin 6.25mg PO 24h
Unasyn 30mg/kg IV q8h
istat chem
pcv/ts
hosp
LRS 8ml/hr
NPO
ADDED:
Unasyn 30mg/kg IV q 8hr
CBC/Chemistry/Lytes- HCT 22%, Neut 17,000, mono 1300

Collect fecal sample
IVF at 1.5 x M
Metronidazole 10mg/kg IV Q12
Cerenia 1mg/kg SQ
Transfer to IM for AUS and additional diagnostics.

Need otic exam +/- cytology
Shyla Myrick MBA, DVM
Diagnostic Request
Ultrasound Guided Aspirate
SAGE In-House Non Integrated Diagnostics
Immunocytochem-VDx (1st stain)
VDx Veterinary Diagnostics
Diagnostic Result
Cytology VDx - Body Fluid (3 sites) (Ref: US10460-DR46983)

Outcome
Report No.
18012108
Grant, Sylvaine & Adam

Jasper US10460-DR46983 Fel, Bengal
M
HISTORY
Fever with high globulins. Suspected FIP. Scant free abdominal fluid unable to sample. Enlarged spleen,
liver, and an abnormally enlarged lymph node.
SPECIMEN
1. Liver. A, B.
2. Spleen. C - E.
3. Lymph node. F - I.
MICROSCOPIC DESCRIPTION
1. Liver: Numerous cords and clusters of hepatocytes are present in a pale lavender mildly bloody
background. A mild component of diffuse or discrete hepatocellular vacuolation is present in some cells.
Throughout the sample most remaining cells are dispersed individually representing a mixture of leukocytes.
Neutrophils appear nondegenerate and appear mildly increased from those commonly expected to be from
this amount of blood. Most of the remaining cells are small mature lymphocytes seen along with occasional
eosinophils. Few basophilic reactive type lymphocytes are seen as well and there are scattered
microvacuolated macrophages. Macrophages sometimes have amorphous pink material within the
cytoplasm.
2. Spleen: Smears have a bloody background with a stroma composed of mononuclear to spindle cells,
sometimes with associated strands of endothelium. Lymphocytes are most numerous and are sometimes
present in monolayered sheets appearing as a mixture. Small mature lymphocytes are most numerous seen
along with expanded numbers of large deeply basophilic lymphocytes and few mature plasma cells. Few
intermediate granular lymphocytes are seen as well. Histiocytes and macrophages are seen individually and
also sometimes in small groups. Most of the remaining cells are slightly toxic nondegenerate neutrophils.
Scattered eosinophils are seen and there are few polygonal cells with morphology most suggestive for
cosampled mesothelium.
3. Lymph node: The pink bloody background entraps low to moderate numbers of nucleated cells.
Lymphocytes compose a heterogeneous mixture. Small mature lymphocytes are seen along with
intermediate and large, sometimes deeply basophilic, lymphocytes. Neutrophils appear slightly toxic and are
increased from those expected to be from the blood. Macrophages are seen individually and in moderately
sized aggregates in some slides. Macrophages are microvacuolated, erythrophagic/ cytophagic and
sometimes have granular pink amorphous material within the cytoplasm. Mast cells are rare.
DIAGNOSIS
1. Liver: Few mixed inflammatory cells with mild mixed hepatocellular vacuolation.
2. Spleen: Moderate lymphoid reactivity.
3. Lymph node: Mild to moderate lymphoid reactivity with moderate neutrophilic to pyogranulomatous
inflammation.
COMMENT
An inflammatory response is most notable in the lymph node that also has the appearance typical for
reactivity. Inflammatory cells are a predominance of neutrophils and macrophages. Etiologies for this type
of response include occult infection (including FIP, protozoal -toxoplasma, etc), response to regional
inflammatory disease (enteritis, vasculitis, pancreatitis, etc), or other similar type of insult. No evidence of
infectious agents is seen despite searching. No features are present to support neoplasia in the node.
It may be possible to further test for FIP by using Corona virus immunocytochemical stain (recommended
on the node). One of the slides submitted for this case could be de-stained and re-stained using this
technique. If you would like to pursue this possibility please call and request FIP. Results are typically
available in 5-7 working days. A positive result strongly supports a diagnosis of FIP. A negative result does
not completely rule out this diagnosis because cells containing the virus may be located in small foci
throughout the organ.
Changes in the liver and spleen are less remarkable. Organisms and features of neoplasia are not apparent.
Hepatocytes are mildly vacuolated, but this is a non-specific change that can be seen with a variety of
acquired conditions. Few inflammatory cells are present here but a specific etiology is not found.
Cells found in this splenic aspirate arecells typically found in aspirates of this tissue. There are not
increased or abnormal spindle cells, excessive immature round cells or unusual hematopoietic precursors.
Enlargement in the spleen may be due to areas of lymphoid hyperplasia, increased blood
pooling/congestion, changes in trabecular structures or similar type processes.
PATHOLOGIST
Joanne Hodges, DVM
Diplomate, American College of
Veterinary Pathologists
Ultrasound - 1 Cavity (OS) (Ref: US10460-DR46984)
Outcome
Veterinary Radiology SpecialistsUltrasound Report
412 Cedar St. Suite D, Santa Cruz CA 95060
Jan 22 2018
Date
1/22/2018
Service
SAGE US + FNA
Clinic
SAGE Veterinary Specialty
Patient
Jasper
Doctor
Dr. Ryan Garcia
Owner
Grant
Signalment
7 mo MN Feline
History_____________________________________________________________________________
Pyrexia, diarrhea in October. Chronic weight loss, elevated globulins, lethargy.
Findings ___________________________________________________________________________
Scant hypoechoic peritoneal and dorsal retroperitoneal fluid.
Liver was diffusely hypoechoic with increased visualization of portal vascular markings. Hepaticechotexture mildly coarse. Normal gall
bladder and biliary ducts. Normal vessels.
Spleen mildly diffusely enlarged with uniform echotexture. Pancreaticoduodenal and jejunal lymph
node were hypoechoic and measured 2 to 10 mm thick with hyperechoic surrounding mesentery.
Normal kidney size and shape bilaterally. Normal tissue texture. No distention of pelves. No pelvicstones. Normal bladder wall thickness.
No stones or sand.
Normal GI tract. No thickening of pancreas or hyperechoic peripancreatic fat.
Normal adrenal gland size and shape bilaterally.
Conclusions _______________________________________________________________________
Hypoechoic liver, splenomegaly, lymphadenopathy, and peritoneal effusion have differentials of
infectious process (such as FIP) or neoplastic infiltrate (such as lymphoma).
Recommendations __________________________________________________________________
Hepatic, lymph node, and splenic FNA performed without immediate complication.
ULTRASOUND REPORT 1/22/2018
Eric Garcia, DVM

Diplomate, ACVR
(Ref: US10460-DR46803)
Outcome
Analyzer: Catalyst_Dx
Analyzer Note:
Test Results Unit Lowest Value Highest Value Qualifier

GLU 95 mg/dL 74 159 =
CREA 1.3 mg/dL 0.8 2.4 =
BUN 15 mg/dL 16 36 =
BUN/CREA 12 =
PHOS 6.8 mg/dL 3.1 7.5 =
CA 10.3 mg/dL 7.8 11.3 =
TP 9.0 g/dL 5.7 8.9 =
ALB 2.8 g/dL 2.2 4.0 =
GLOB 6.2 g/dL 2.8 5.1 =
ALB/GLOB 0.5 =
ALT 48 U/L 12 130 =
ALKP 40 U/L 14 111 =
GGT 0 U/L 0 4 =
TBIL 0.3 mg/dL 0.0 0.9 =
CHOL 82 mg/dL 65 225 =
Na 157 mmol/L 150 165 =
K 3.8 mmol/L 3.5 5.8 =
Na/K 41 =
Cl 115 mmol/L 112 129 =
Osm Calc 310 mmol/kg =
(Ref: US10460-DR46803)
Outcome
Analyzer: Coag_Dx
Analyzer Note:

cit-aPTT 86.0 seconds 65.0 119.0 =
(Ref: US10460-DR46803)
Outcome
Analyzer: ProCyte_Dx
Analyzer Note:

RBC 6.89 M/μL 6.54 12.20 =
HCT 20.5 % 30.3 52.3 =
HGB 7.8 g/dL 9.8 16.2 =
MCV 29.8 fL 35.9 53.1 =
MCH 11.3 pg 11.8 17.3 =
MCHC 38.0 g/dL 28.1 35.8 =
RDW 32.1 % 15.0 27.0 =
%RETIC 0.2 % =
RETIC 16.5 K/μL 3.0 50.0 =
WBC 28.89 K/μL 2.87 17.02 =
%NEU 59.9 % =
%LYM 36.0 % =
%MONO 1.8 % =
%EOS 2.0 % =
%BASO 0.3 % =
NEU 17.30 K/μL 1.48 10.29 =
LYM 10.40 K/μL 0.92 6.88 =
MONO 0.53 K/μL 0.05 0.67 =
EOS 0.58 K/μL 0.17 1.57 =
BASO 0.08 K/μL 0.01 0.26 =
PLT 332 K/μL 151 600 =
MPV 18.1 fL 11.4 21.6 =
PCT 0.60 % 0.00 0.79 =
(Ref: US10460-DR46803)
Outcome
Analyzer: Coag_Dx
Analyzer Note:

cit-PT 14.0 seconds 15.0 22.0 =
PCV/TS (In House) (Ref: US10460-DR46842)

PCV 28
TS 8.8
Ultrasound - Inpatient Recheck (Ref: US10460-DR46690)
Ultrasound - Abdomen (Ref: US10460-DR46507)
Outcome
An abdominal ultrasound was performed. There was trace free fluid- small pocket near bladder and tiny amount within mesentery near
left pancreas.
The liver was of normal size and diffusely hypoechoic. No abnormalities were noted in the gall bladder, biliary ducts or vasculature. GB
1.15 cm,
The spleen was mildly enlarged and lacy echotexture on linear probe 0.91 cm
The stomach was within normal limits. The intestines had normal layering and wall thickness. There was one mesenteric LN 0.85 X 1.97
cm lateral to right kidney.
The left pancreas was visible and hypoechoic
The kidneys were of normal shape and size bilaterally, with normal texture and good cortico-medullary definition. There was no
distention of the renal pelves and no pelvic stones. The urinary bladder was with in normal limits with a uniform bladder wall of normal
thickness. No stones or sand noted. LK 3.62 RK 3.60
There were no other abnormalities noted.
A: hypoechoic liver
mild splenomegaly with lacy texture
small free fluid
single mesenteric LN
left pancres visible and hypoechoic
Recommend sedation: FNA liver, spleen, ascites ( if more present) after coags performed
(Ref: US10460-DR46458)

Sodium 152 mmol/L 147 162
Potassium 3.6 mmol/L 2.9 4.2
Chloride 121 mmol/L 112 129
Ionized Calcium 1.33 mmol/L 1.2 1.32
TCO2 21 mmol/L 16 25
Glucose 113 mg/dl 60 130
BUN 18 mg/dl 15 34
Creatinine 0.9 mg/dl 1.0 2.2
HCT 26 % 24 40
Hemoglobin 8.8 g/dl 8 13
Anion Gap 14 mmol/L 10 27
PCV 27
TS 9.2
URINALYSIS(910) (Ref: US10460-DR9453)

COLLECTION METHOD CYSTOCENTESIS
COLOR Yellow
CLARITY CLEAR
SPECIFIC GRAVITY 1.053
GLUCOSE NEGATIVE
BILIRUBIN NEGATIVE
KETONES NEGATIVE
BLOOD NEGATIVE
PH 6.5
PROTEIN NEGATIVE
Protein test is performed and confirmed by the sulfosalicylic acid test.
WBC 0-2 HPF 5
RBC 0-2 HPF
BACTERIA NONE SEEN
EPI CELL RARE (0-1)
MUCUS NONE SEEN
CASTS NONE SEEN
CRYSTALS NONE SEEN
OTHER
NON-CRYSTALLINE DEBRIS PRESENT
UROBILINOGEN NORMAL
CHEM 25 w/ SDMA(111) (Ref: US10460-DR9453)

ALP 90 U/L 12 59
ALT 48 U/L 27 158
AST 18 U/L 16 67
CREATINE KINASE 99 U/L 64 440
GGT <1 U/L 6
ALBUMIN 2.9 g/dL 2.6 3.9
TOTAL PROTEIN 7.1 g/dL 6.3 8.8
GLOBULIN 4.2 g/dL 3.0 5.9
TOTAL BILIRUBIN 0.1 mg/dL 0.0 0.3
BILIRUBIN CONJUGATED <0.1 mg/dL 0.0 0.2
BUN 23 mg/dL 16 37
CREATININE 1.1 mg/dL 0.9 2.5
CHOLESTEROL 106 mg/dL 91 305
GLUCOSE 98 mg/dL 72 175
CALCIUM 10.1 mg/dL 8.2 11.2
PHOSPHORUS 7.6 mg/dL 2.9 6.3
TCO2 (BICARBONATE) 18 mmol/L 12 22
CHLORIDE 115 mmol/L 114 126
POTASSIUM 4.6 mmol/L 3.7 5.2
SODIUM 147 mmol/L 147 157
ALB/GLOB RATIO 0.7 0.5 1.2
BUN/CREATININE RATIO 20.9
BILIRUBIN UNCONJUGATED 0.0 mg/dL 0.0 0.2
NA/K RATIO 32 29 42
HEMOLYSIS INDEX N
Index of N, 1+, 2+ exhibits no significant effect on chemistry values.
LIPEMIA INDEX N
Index of N, 1+, 2+ exhibits no significant effect on chemistry values.
ANION GAP 19 mmol/L 12 25
SDMA 13 ug/dL 14
BOTH SDMA AND CREATININE ARE WITHIN THE REFERENCE INTERVAL which indicates kidney function is likely good. Evaluate a
complete urinalysis and confirm there is no other evidence of kidney disease.
T4(804) (Ref: US10460-DR9453)

T4 1.3 ug/dL 0.8 4.7
Interpretive ranges: <0.8 Subnormal 0.8-4.7 Normal 2.3-4.7 Grey zone in old or symptomatic cats >4.7 Consistent with
hyperthyroidism Cats with subnormal T4 values are almost exclusively euthyroid sick or overtreated for their hyperthyroidism. Older
cats with consistent clinical signs and T4 values in the grey zone may have early hyperthyroidism or a concurrent non-thyroidal illness.
Hyperthyroidism may be confirmed in these cats by adding on a free T4 or by performing a T3 suppression test. Following treatment
with methimazole, T4 values will generally fall within the lower end of the reference range (0.8 - 2.3).
CBC COMPREHENSIVE(300) (Ref: US10460-DR9453)

WBC 11.3 K/uL 3.9 19.0
RBC 7.53 M/uL 7.12 11.46
HGB 9.4 g/dL 10.3 16.2
HCT 27.1 % 28.2 52.7
MCV 36 fL 39 56
MCH 12.5 pg 12.6 16.5
MCHC 34.7 g/dL 28.5 37.8
% RETICULOCYTE 0.1 %
RETICULOCYTE 8 K/uL 3 50
RETICULOCYTE COMMENT
A reticulocyte count of greater than 50 K/uL of blood is considered evidence of bone marrow response to an increased peripheral
demand. Depending on the degree of anemia, a reticulocyte count <50 K/uL may indicate an inadequate bone marrow response. Serial
monitoring of the erythrogram and absolute reticulocyte count may be useful to evaluate bone marrow responsiveness over time. The
following chart can be used as a guideline to determine appropriateness of regenerative response. Degree of bone marrow response
(K/uL): Mild 50-75 Moderate 75-175 Marked >175
% NEUTROPHIL 33.9 %
% LYMPHOCYTE 57.5 %
% MONOCYTE 4.5 %
% EOSINOPHIL 4.0 %
% BASOPHIL 0.1 %
PLATELET 359 K/uL 155 641
ANISOCYTOSIS SLIGHT
REMARKS
SLIDE REVIEWED MICROSCOPICALLY. KERATOCYTES - SLIGHT NO FELINE HEMOTROPIC MYCOPLASMAS (FHM, formerly Hemobartonella)
seen. IF FHM IS SUSPECTED, THE IDEXX RealPCR FOR FHM IS MORE SENSITIVE THAN BLOOD FILM REVIEW. UNIT CODE 1717.
NEUTROPHIL 3831 /uL 2620 15170
LYMPHOCYTE 6498 /uL 850 5850
MONOCYTE 509 /uL 40 530
EOSINOPHIL 452 /uL 90 2180
BASOPHIL 11 /uL 100
Ultrasound - Inpatient Recheck (Ref: US10460-DR9447)
Outcome
Unallocated result from Vet Rocket - the below details might help you find out which patient it belongs to:
Modality: Ultrasound
Accession Number:
Study Date: 10-11-2017 9:15:19am
Patient Id: 170112
Patient Name: GRANT,,JASPER
Study Description:
Referring Physicians Name:
Clinic Notes / Specifics

Brief u/s: Wisp of free fluid near head of spleen. Static splenic anechoic structure (suspect cyst).
RSG
Outcome
SAGE - CAMPBELL
907 DELL AVENUE
CAMPBELL, California 95008
408-343-7243
Account # 4991
Owner: GRANT
Patient: JASPER
Species: FELINE
Breed: BENGAL
Age: 6M
Gender: MALE
Requisition #: 170112
Accession #: 8200480740
Order recv'd: 10/6/2017
Ordered by: GARCIA,RYAN
FECAL O&P + GIARDIA

Test Result Reference Range
GIARDIA ELISA NEGATIVE
OVA & PARASITES
NO OVA OR PARASITES SEEN
In cases of acute or chronic diarrhea in addition to a fecal floatation and antigen testing for ova and parasites consider testing
for viral, bacterial and protozoal infectious agents using RealPCR (canine diarrhea panel: test code 2625; feline diarrhea panel: test code
2627).
FELINE DIARRHEA PANEL COMP

Test Result Reference Range
TRITRICHOMONAS FOETUS PCR NEGATIVE
CRYPTOSPORIDIUM by RealPCR NEGATIVE
GIARDIA SP by RealPCR NEGATIVE
SALMONELLA PCR NEGATIVE
TOXOPLASMA GONDII NEGATIVE
FELINE CORONA VIRUS POSITIVE
FELINE PANLEUKOPENIA VIRUS NEGATIVE
CAMPYLOBACTER JEJUNI PCR NEGATIVE
CAMPYLOBACTER COLI PCR NEGATIVE
C. PERF ALPHA TOXIN GENE NEGATIVE
C.PERF ENTEROTOXIN GENE (1) NEGATIVE
Comments:
(1) A POSITIVE FELINE DIARRHEA PANEL PCR result indicates that the nucleic
acid (DNA or RNA) of that organism(s) was detected in the fecal
sample. In a patient with diarrhea, this supports infection.
Vaccination with a modified live coronavirus vaccine may result in a
positive result for up to a few weeks post-vaccination.
Clostridium perfringens toxin genes (CPA and CPE) positive PCR results
should be interpreted based on their quantitative levels. Note that
recent or concurrent antibiotic therapy against Clostridium will lower
the quantitative levels. In animals with CPA or CPE gene copies >300
Thous/g feces, the toxin may be contributing to clinical signs of
diarrhea. In animals where the number of copies of the gene is below
the cut-off, this toxin is unlikely to be contributing to diarrhea.
A NEGATIVE FELINE DIARRHEA PANEL PCR result indicates that the nucleic
acid (DNA or RNA) of that organism(s) was not detected in the sample
submitted. However, a negative PCR result may be caused by the
number of organisms being below the limit of detection, decreased
numbers of organisms following treatment or chronic carrier state, or
the occurrence of a new strain variation.
(Ref: )
Outcome
Doppler/Echocardiogram:
IVSd (mm): 3.5
IVSs (mm): 6.7
LVFWd (mm): 3.7
LVFWs (mm): 4.9
LVIDd (mm): 14.8
LVIDs (mm): 6.3
FS: 57.7 %
LA (mm): 8.0, Ao (mm): 6.9, LA/Ao: 1.16
AV Vmax (m/s): 1.41

PV Vmax (m/s): 1.26
MV E (m/s): 1.21
Echocardiogram:
Normal left ventricular chamber dimensions and function. The left ventricular walls are normal thickness without outflow narrowing.
The left atrium is normal in size. Normal to slightly prominent right ventricular and atrial size. The mitral valve is normal without note
of systolic anterior motion. The tricuspid valve appears normal in structure. Unremarkable aortic and pulmonic valves. Normal aorta
and pulmonary artery. No pleural or pericardial effusion observed. No spontaneous echo-contrast or in-situ thrombus.
Doppler:
No mitral regurgitation. Trace tricuspid regurgitation with a normal velocity. Normal left and right ventricular outflow tract velocities
without evidence of dynamic outflow obstructions. Transmitral flows are summated. No evidence of an ASD (carefully interrogated due
to prominent right side, could not be demonstrated), VSD, or PDA.
Assessment:
Normal adult size heart. All chambers are proportionally appropriate and there are no flow abnormalities. There is no evidence of other
organs within the pericardial sac (PPDH). Apparently the appearance of marked cardiomegaly on thoracic radiographs is due to his
small body size with a heart that is a normal adult size. The significance of this is unknown but I suspect his heart is normal and will
tolerate the necessary treatments for his other disease.
Clinic Notes / Specifics

Doppler/Echocardiogram:
IVSd (mm): 3.5
IVSs (mm): 6.7
LVFWd (mm): 3.7
LVFWs (mm): 4.9
LVIDd (mm): 14.8
LVIDs (mm): 6.3
FS: 57.7 %
LA (mm): 8.0, Ao (mm): 6.9, LA/Ao: 1.16
AV Vmax (m/s): 1.41

PV Vmax (m/s): 1.26
MV E (m/s): 1.21
Echocardiogram:
Normal left ventricular chamber dimensions and function. The left ventricular walls are normal thickness without outflow narrowing.
The left atrium is normal in size. Normal to slightly prominent right ventricular and atrial size. The mitral valve is normal without note
of systolic anterior motion. The tricuspid valve appears normal in structure. Unremarkable aortic and pulmonic valves. Normal aorta
and pulmonary artery. No pleural or pericardial effusion observed. No spontaneous echo-contrast or in-situ thrombus.
Doppler:
No mitral regurgitation. Trace tricuspid regurgitation with a normal velocity. Normal left and right ventricular outflow tract velocities
without evidence of dynamic outflow obstructions. Transmitral flows are summated. No evidence of an ASD (carefully interrogated due
to prominent right side, could not be demonstrated), VSD, or PDA.
Assessment:
organs within the pericardial sac (PPDH). Apparently the appearance of marked cardiomegaly on thoracic radiographs is due to his
small body size with a heart that is a normal adult size. The significance of this is unknown but I suspect his heart is normal and will
tolerate the necessary treatments for his other disease.
Outcome
PCV 23% and TS 6.8 g/dl
Outcome
I-Stat 8 Wednesday, October 04, 2017
sodium 145 147-162

potassium 3.5 2.9-4.2
chloride 122 112-129
ionized calcium 1.21 1.2-1.32
TCO2 18 16-25
glucose 104 60-130
BUN 15 15-34
creatinine 0.4 1.0-2.2
HCT 18 24-40
Hgb 6.1 8-13
anion gap 10 10-27
Outcome
Two view thorax: Generalized enlargement of the cardiac silhouette, no pulmonary lesions, no pleural effusion, no osseous lesions.
Outcome
pcv 21% tp 7.0 mg/dL
clear - jcc
Outcome
Patient Jasper
Owner Grant
Signalment 4 mo. Bengal
Service sS_A4G5E 1 cavity US
SAGE Veterinary Specialty
Dr. Ryan Garcia
tgr.176
Doctor dr.773
ULTRASOUND REPORT 10/4/2017
HISTORY:
FUO. Diarrhea.
FINDINGS:
A tiny amount of abdominal fluid is present near the spleen.
Normal liver size with slightly coarse texture in all lobes. No nodules or masses. Normal gall bladder and biliary ducts. Normal vessels.
Normal thickness of spleen. A small 4 mm thin walled round structure containing anechoic fluid is present in the mid spleen. Mild 4 mm
mesenteric lymphadenopathy.
Normal kidney size and shape bilaterally. Normal tissue texture. No distention of pelves. No pelvic stones. Normal bladder wall
thickness. No stones or sand.
Normal empty GI tract.
No thickening of pancreas or hyperechoic peripancreatic fat.
FINDINGS:
No significant GI lesions.
Slightly coarse hepatic texture. DDX: Normal, early fibrosis.
Mild mesenteric lymphadenopathy, common in normal young patients.
Small splenic cyst.
Tiny amount of abdominal fluid.
Larry Y Kerr, DVM

Diplomate, ACVR
Outcome
Catalyst Chemistry 10/3/2017
glucose 135 74-159 mg/dl

BUN 20 16-36 mg/dl
creatinine 0.9 0.8-2.4 mg/dl
BUN/CREA 22
phosphorus 7.7 3.1-7.5 mg/dl
calcium 10.5 7.8-11.3 mg/dl
total protein 7.8 5.7-8.9 g/dl
albumin 2.9 2.3-3.9 g/dl
globulin 4.9 2.8-5,1 g/dl
alb/glob 0.6
ALT 40 12-130 U/L
ALP 35 14-111 U/L
GGT 0 0-4 U/L
T. bilirubin 0.2 0.0-0.9 mg/dl
cholesterol 122 65-225 mg/dl
amylase 357 500-1500 U/L
lipase 245 100-1400 U/L
sodium 156 150-165 mmol/L

potassium 3.9 3.5-5.8 mmol/L
chloride 114 112-129 mmol/L
CBC (10/3/2017)
RBC: 6.65 (6.54-12.2 M/ul)
HCT: 22.4 (30.3-52.3 %)
HGB: 8.1 (9.8-16.2 g/dl)
MCV: 33.7 (35.9-53.1 fL)
MCH: 12.2 (11.8-17.3 pg)
MCHC: 36.2 (28.1-35.8 g/dL)
RDW: 27.6 (15-27%)
%Reticulocyte: 0.2
Reticulocyte: 16.0 K/uL (3-50 K/uL)
WBC: 24.85 (2.87-17.02 K/uL)
%neutrophils: 69.4
%lymphocytes: 24.0
%monocytes: 5.2
%eosinophil: 1.3
%basophil: 0.1
neutrophils: 17.23 (1.48-10.29 K/uL)
lymphocytes: 5.96 (0.92-6.88 K/uL)
monocytes: 1.30 (0.05-.67 K/uL)
eosinophil: 0.33 (0.17-1.57 K/uL)
basophil: 0.03 (0.01-0.26 K/uL)
platelets: 344 (151-600 K/uL)
MPV: 18.0 fL
Therapeutic / Procedure
Specifics
Gave 0.25mg/kg (0.08ml butorphanol IV) for sedated ultrasound guided FNA of enlarged lymph node, spleen & liver. Sedation not
enough for LN, propofol titrated IV was successful for aspirating LN. del
Medication
Prescribed
Date/Time Drug Name Qty Instructions
By
01-22-2018 Maropitant Citrate 16mg Tablets B40 4 PLEASE GIVE 1/2 OF A TABLET BY MOUTH ONCE Dr. Ryan
4:39:45pm (Per Tablet) . DAILY FOR NAUSEA. #4 1 REFILL. RSG Garcia
. . . .
01-22-2018 Marbofloxacin 25mg Tablets B100 (Per 5 PLEASE GIVE 1/2 OF A TABLET BY MOUTH ONCE Dr. Ryan
4:36:01pm Tablet) . DAILY. #5 1 REFILL. RSG Garcia
. . . .
01-22-2018 Fluids LRS Inj Bag 1000mL (Per mL) 1 PLEASE GIVE 75 ML OF FLUID UNDER THE SKIN Dr. Ryan
4:36:01pm . . ONCE DAILY. #1 1 REFILL. RSG Garcia
. . .
01-22-2018 Butorphanol 10mg/mL Injection C4 0.08 IV FOR SEDATION Dr. Ryan
2:02:55pm 10mL (Per mL) . . Garcia
. . .
10-20-2017 Metronidazole 50mg/ml Suspension (5 5 GIVE 0.4ML BY MOUTH TWICE A DAY. STOP IF Dr. Ryan
11:52:50am Day Supply) B480 (Per mL) . BALANCE ISSUES ARE SEEN Garcia
. . . .
10-11-2017 Metronidazole 50mg/ml Suspension (5 5 GIVE "JASPER" 0.4ML BY MOUTH TWICE DAILY WITH Dr. Ryan
11:17:33am Day Supply) B480 (Per mL) . FOOD. STOP IF BALANCE ISSUES ARE SEEN. REFILL Garcia
. . 1 TIMES. .
.
10-05-2017 CONVERTED-MEDICATION 1 Amoxi/Clavu Drops 62.5mg qty. 1 Rx: Give "Jasper" Dr. Ryan
5:54:29pm . . 0.5mL by mouth every 12 hours with food. Refill 1 Garcia
. times. Marbofloxacin Tabs 25mg qty. 3 Rx: Give .
"Jasper" 1/4 tablet by mouth once daily, ideally with
food. No refills Metronidazole Susp 50mg/ml (5 Day)
qty. 5 Rx: Give "Jasper" 0.4mL by mouth twice daily
with food. Stop if balance issure are seen. Refill 1
times. PrednisOLONESyrup 15mg/5ml qty. 10 Rx:
Give "Jasper" 0.6mL by mouth once daily. Do not
start until instructed by Dr. Garcia. Refill 1 times.
.
10-05-2017 CONVERTED-MEDICATION 1 Clavamox 62.5 mg/ml: Please give 0.5 ml orally Dr. Ryan
5:41:53pm . . every 12 hours with food. 1 box, 1 refill Garcia
. Marbofloxacin 25 mg tablets: Please give 1/4 of a .
tablet by mouth once daily, ideally with food. #3 1
refill. Metronidazole 50 mg/ml: Please give 0.4 ml
orally every 12 hours with food. Stop if balance
issues are seen. #5 1 refill. Prednisolone 15
mg/5ml: Please give 0.6 ml orally once daily. Do not
start until Oked by Dr. Garcia. #10 1 refill. RSG
.
In Clinic Notes
Jasper remains hospitalized for fever, hyporexia, and a hx of scant FF and new hyperglobulinemia; previously seen by RG for work up of
diarrhea with high coronavirus PCR noted. Has non-regenerative anemia and leukocytosis. AUS showed one enlarged mesenteric LN and
changes to liver/spleen.
BCS 4/9; 1/6 HM: abdomen soft on palpation; femoral pulse quality adequate; eupneic.
T = 104.2 F at 10 PM
T = at 2 AM at 4 AM
T = at 6 AM
Ate well at 11 PM when cone was off or when hand fed- NPO at 12 AM for likely sedated AUS guided aspirates tomorrow
Transfer to IM for further management.
S: hx persistent diarrhea since adoption
10/2017
Fecal: negative
PCV/TS: 21/7
Chem 8: normal
CBC/CHEM (10/3/17): nonregenerative anemia
AUS: Slightly coarse hepatic texture. Mild mesenteric lymphadenopathy, Small splenic cyst.
Tiny amount of abdominal fluid.
2 view CXR: mild cardiomegaly
feline diarrhea panel: positive for corona
echo: normal
repeat CBC/CHEM (10/11/17): nonregenerative anemia, mild elevation ALP/phos (young)
T4: normal
UA: normal, USG 1053
1/16/18 PDVM visit
CBC: HCT 24.3 nonregenerative anemia; WBC 25.6K lymphocytosis
CHEM: glob 6.4, phos 7.3, glu 64 (sendout)
T4: normal
UA: USG 1043
FIV/FELV: Neg
O:
PHYSICAL EXAM:
BAR. aggressive BCS: 6/9 mm:light pink CRT:2 sec pulse quality: strong, synchronous, symmetric
EENT: no abnormal oculonasal discharge. AU clean. mild gingivitis, no tartar
SKIN:full coat, no evidence of ectoparasites
H/L:1/6 parasternal murmur, no crackles, wheezes or arrhythmias
ABD:soft, no pain or palpable organomegaly
MS:ambulatory X 4, adequately muscled
LN (peripheral): normal character and size
UROGEN: bladder soft, no abnormal preputial discharge. did not attempt to palpate testicles due to development of aggression as exam
progressed
RECTAL: not performed
A:
FUO R/O neoplasia (eg lymphoma) vs infection (eg FIP, FELV/FIV, calicivirus) vs immunemediated
P:
AUS: hypoechoic liver, mild splenomegaly with lacy texture,small free fluid, single mesenteric LN
left pancreas visible and hypoechoic
unasyn 30mg/kg IV q8
LRS 8ml/h
Robenacoxib - HOLD (client brought in)
Iron supplements - HOLD (client brought in)
Jasper remains hospitalized for hyporexia and recurrent fever of 104F. Currently managed on clavamox, onsior, and IVF with AFAST
today showing scant FF and possible lymphadenopathy.
BCS 3/9; slightly fractious; eupneic; abdomen soft on palpation and not painful, femoral pulse quality adequate, MM pale pink,
ambulatory x 4.
No interest in food.
10PM: 102.4F temp
2AM: 103.7F
6 AM 104.3 F - put fan on
hold on clavamox/ onsior as not eating
NPO at 12 AM for AUS tmr
FOOD SAMPLES: 2 cans RC duck wet per RG. DEL
Contact # today: 917-587-0199. Niece can pick up earlier, or Mom can pick up 5:30 - 6p, after work. DEL
Today's weight was 1.72 kg (1.8 kg).
Jasper, a 5 MO MI Bengal, was transferred to the SAGE IM service yesterday for further work up of diarrhea and fever.
Seen at Curtner 9/8/17 for diarrhea. Afebrile at that time (101.3) Labs performed Fecal O&P, (neg), CBC: WBC: 26.2k, HCT: 30.8%, NN
55k retics, Plt: 366, Neuts: 12655, Lymph: 11397, Chem: ALP: 73, Alb: 3.1, Glob: 3.1, BUN: 29, Creat: 0.8, tT4: 3.2. FeLV/FIV neg/neg. Vit
B12 200 mcg sq, Rx metronidazole, fenbendazole, Fortiflora (no doses listed).
Seen 9/24/17: Fecal PCR; Positive for FeCoV PCR, CPerf (27k; <300k). Notes not available.
9/30/17: Seen by Dr. Rubin (verbally reported). Colonic lavage for repeat Tritrich PCR: Negative. Repeat labs: Alb: 3.1, Glob: 3.8, WBC:
10.9, HCT: 26.1%, NN 14k retics. Neuts: 5276, Plt: 372k, FeLV/FIV neg/neg. USG: 1.054, quiet sediment.
No improvement in diarrhea with medications Rxed.
Eating well until 3d ago, lethargic, hyporexic. Owner concerned about fever. Brought to SAGE.
Indoor only only cat (other cat in house suspected to have succumbed to FIP in 09/2017; renomegaly, pleural effusion,
No T/T/T/T, no C/S/V, good energy outside of last three days.
UPDATE:
Febrile, eating, ongoing soft stool. FeCoV PCR (blood) negative, FeCoV titer 1:12800. Owner elects discharge.
EXAM:
GA: BAR/meowing. Ambulatory x4. hydrated based on skin turgor and tear film. BCS: 4/9, MSS: 2/3.
pulses appreciated.
soft/smooth/nonpainful. Urinary bladder <2 cm, soft, smooth, nonpainful. Rectal: soft brown feces on rectal. No masses, smooth
mucosa, empty anal sacs bilaterally with no masses. Urethra soft/smooth. Prostate palpates soft/smooth and symmetric, appropriate for
castrated male.
Integ: IVC in shaved cephalic.Shaved abdomen, otherwise full clean coat,
changes absent OU. Ears normal/ normal odor, no nasal discharge. Oral: No dental calculus, adult dentition, no masses, no obvious
T: 102.7-103.5 throughout the day.
DIAGNOSTICS:
10/5/17:
FeCoV PCR (whole blood): Negative
FeCoV titer: 1:12800
Echo:
organs within the pericardial sac (PPDH). Apparently the appearance of marked cardiomegaly on thoracic radiographs is due to his small
body size with a heart that is a normal adult size. The significance of this is unknown but I suspect his heart is normal and will tolerate
the necessary treatments for his other disease.
Brief AFAST: Scant effusion. No pericardial effusion.
PCV 23% and TS 6.8 g/dl
Echo:
10/4/17:
VRUS u/s: GI WNL. Coarse hepatic echotexture, mild mesenteric lymphadenopathy, splenic cyst, scant abd. effusion.

clear -
Two view thorax: Generalized enlargement of the cardiac silhouette, no pulmonary lesions, no pleural effusion, no osseous lesions.
10/3/17:
CBC (IH): HCT: 22.4%, NN 16k retics, WBC: 24.85k, Neuts: 17.23, Mono: 1300, Plt: 344k.
Chem: Glu: 135, Creat: 0.9, BUN: 20, Glob: 4.9 (H), Alb: 2.9, ALT: 40, Chol: 122, Na: 156, K: 3.9.
PROBLEM LIST:
Pyrexia
Diarrhea
Anemia
Cardiomegaly
Fecal FeCoV+
ASSESSMENT:
Pyrexia: Open. No focus found on interrogation of either cavity. R/O GI based on history. Differentials bacterial, viral (FIP vs other) vs
inflammatory/immune vs neoplastic (less likely). Monitor in light of antibiotic therapy.. If further work up (consider hepatic FNA, fluid
sampling if available, GI biopsies given diarrhea) not feasible, consider prednisolone for inflammatory/FIP.
Diarrhea: Open. R/O infectious (bacterial, FIP) vs protozoal (Tritrich, other) vs inflammatory/IBD. No cause elucidated despite multiple
fecals and colonic lavage. Tritrich fits with signalment and some of diarrhea history but refuted with serial Tritrich PCRs. Work up as
above, consider GI biopsy to be definitive. Submit repeat fecal O/P/PCR at owner request. Consider B12 supplementation, repeat
fenbendazole trial.
Anemia: Open. R/O secondary to inflammation vs loss (preregenerative) vs marrow vs destructive. Historically WNL, argues for anemia
of inflammation though other causes cannot be ruled out. Consider CBC to lab, monitoring.
from suspected house with other cat with FIP. Consider sampling of fluid (abd) if available, GI biopsies as above.
PLAN:
hosp
LRS 8ml/hr
NPO
TPR q4h
marbofloxacin 6.25 mg PO q24h
iStat 0000h.
1700h: Owner elects discharge. Further work up declined. If patient remains persistently febrile, consider prednisolone.
PENDING:
Fecal O/P and PCR.
Rx:
Marbofloxacin 25 mg tablets: Please give 1/4 of a tablet by mouth once daily, ideally with food. #3 1 refill.
RECHECK:
Update/temperature in 24h, recheck in one week.
RSG
Jasper is BAR and vocal, he continues to have diarrhea but otherwise appears comfortable
PE
Mentation: vocal, alert, responsive
Cardiovascular: no murmur or arrhythmia ausculted, mm = pink, pulses strong and synchronous
Respiratory: eupneic, clear lung sounds bilaterally
Abdomen: soft and non-painful on palpation
Today's weight was 1.8 kg.

Jasper, a 5 MO MI Bengal, was transferred to the SAGE IM service for further work up of diarrhea and fever.
Seen at Curtner 9/8/17 for diarrhea. Afebrile at that time (101.3) Labs performed Fecal O&P, (neg), CBC: WBC: 26.2k, HCT: 30.8%, NN
55k retics, Plt: 366, Neuts: 12655, Lymph: 11397, Chem: ALP: 73, Alb: 3.1, Glob: 3.1, BUN: 29, Creat: 0.8, tT4: 3.2. FeLV/FIV neg/neg. Vit
B12 200 mcg sq, Rx metronidazole, fenbendazole, Fortiflora (no doses listed).
Seen 9/24/17: Fecal PCR; Positive for FeCoV PCR, CPerf (27k; <300k). Notes not available.
9/30/17: Seen by Dr. Rubin (verbally reported). Colonic lavage for repeat Tritrich PCR: Negative. Repeat labs: Alb: 3.1, Glob: 3.8, WBC:
10.9, HCT: 26.1%, NN 14k retics. Neuts: 5276, Plt: 372k, FeLV/FIV neg/neg. USG: 1.054, quiet sediment.
No improvement in diarrhea with medications Rxed.
Eating well until 3d ago, lethargic, hyporexic. Owner concerned about fever. Brought to SAGE.
Indoor only only cat (other cat in house suspected to have succumbed to FIP in 09/2017; renomegaly, pleural effusion,
No T/T/T/T, no C/S/V, good energy outside of last three days.
UPDATE:
Febrile, eating, no diarrhea.
EXAM:
GA: BAR/meowing. Ambulatory x4. hydrated based on skin turgor and tear film. BCS: 4/9, MSS: /3.
pulses appreciated.
soft/smooth/nonpainful. Urinary bladder 2 cm, soft, smooth, nonpainful. Rectal: soft brown feces on rectal. No masses, smooth mucosa,
empty anal sacs bilaterally with no masses. Urethra soft/smooth. Prostate palpates soft/smooth and symmetric, appropriate for
castrated male.
Integ: IVC in shaved cephalic. Full clean coat,
changes absent OU. Ears normal/ normal odor, no nasal discharge. Oral: No dental calculus, adult dentition, no masses, no obvious
DIAGNOSTICS:
10/4/17:
VRUS u/s: GI WNL. Coarse hepatic echotexture, mild mesenteric lymphadenopathy, splenic cyst, scant abd. effusion.

clear -
Two view thorax: Diffuse enlargement of the cardiac silhouette, no pulmonary lesions, no pleural effusion, no osseous lesions.
10/3/17:
CBC (IH): HCT: 22.4%, NN 16k retics, WBC: 24.85k, Neuts: 17.23, Mono: 1300, Plt: 344k.
Chem: Glu: 135, Creat: 0.9, BUN: 20, Glob: 4.9 (H), Alb: 2.9, ALT: 40, Chol: 122, Na: 156, K: 3.9.
PROBLEM LIST:
Pyrexia
Diarrhea
Anemia
Cardiomegaly
Fecal FeCoV+
ASSESSMENT:
Pyrexia: Open. No focus found on interrogation of either cavity. R/O GI based on history. Differentials bacterial, viral (FIP vs other) vs
inflammatory/immune vs neoplastic (less likely). Monitor in light of antibiotic therapy, consider addition of marbofloxacin if no
improvement. If further work up (consider hepatic FNA, fluid sampling if available, GI biopsies given diarrhea) not feasible, consider
prednisolone for inflammatory/FIP.
Diarrhea: Open. R/o infectious (bacterial, FIP) vs protozoal (Tritrich, other) vs inflammatory/IBD. No cause elucidated despite multiple
fecals and colonic lavage. Tritrich fits with signalment and some of diarrhea history but refuted with serial Tritrich PCRs. Work up as
above, consider GI biopsy to be definitive.
Anemia: Open. R/O secondary to inflammation vs loss (preregenerative) vs marrow vs destructive. Historically WNL, argues for anemia
of inflammation though other causes cannot be ruled out. Consider CBC to lab, monitoring.
Cardiomegaly: Open. R/O artifact vs structural heart disease. Consider echo.
from suspected house with other cat with FIP. Consider sampling of fluid (abd) if available, FeCoV PCR (blood) to look for active
infection, FeCoV titers.
PLAN:
hosp
LRS 8ml/hr
NPO
TPR q4h
Add marbofloxacin 6.25 mg PO q24h in AM if persistently febrile
iStat 0000h.
2000h: Eating well. BAR.
PENDING:
FeCoV PCR, FeCoV titers (Idexx)
RSG
Jasper is BAR, eating and appears comfortable
PE
Mentation: quiet, alert, responsive
Cardiovascular: no murmur or arrhythmia ausculted, mm = pink, pulses strong and synchronous
Respiratory: eupneic, purring
Abdomen: soft and non-painful on palpation
Discharge Summaries
Diagnosis:
Fever, enlarged lymph nodes liver/spleen enlargement
Assessment:
Thank you for bringing Jasper to SAGE; he is a sweet, handsome boy as always. Jasper was admitted for hospitalization for further
workup of his fever and lethargy.
He has an area of back pain on his exam that may explain why he is vocalizing hen being picked up. His x-rays from Curtner do not
show an obvious cause for his back pain, and it may be due to a problem within the spinal cord or surrounding tissues. An MRI would be
needed to further investigate this and the underlying cause.
As importantly, Jasper has several changes in his abdomen that were not appreciated on his ultrasound in October. His lier, spleen and
lymph nodes all look abnormal. These combined changes make us worried for conditions such as cancer or a viral cause like FIP
(especially given his history). We were unable to sample fluid from his belly again, but e were able to sample the spleen, liver and
lymph nodes. These will help us look for a pattern of inflammation that we can see in cats with FP though a definitive diagnosis usually
requires fluid or a true biopsy (piece) of tissue. The aspirates will potentially strengthen our suspicion for FIP and help us rule out other
underlying causes.
Jasper is still running a fever, but since he is eating, we are sending him home with you as you would like to give him fluids at home.
These will work to keep him hydrated and help blunt his fever slightly. We are going to start a new antibiotic while we await the
cytology (which should return tomorrow).
Medications:
Drug Name Instructions

PLEASE GIVE 1/2 OF A TABLET BY MOUTH ONCE DAILY FOR NAUSEA. #4 1
Maropitant Citrate 16mg Tablets B40 (Per Tablet)
REFILL. RSG
Marbofloxacin 25mg Tablets B100 (Per Tablet) PLEASE GIVE 1/2 OF A TABLET BY MOUTH ONCE DAILY. #5 1 REFILL. RSG
Fluids LRS Inj Bag 1000mL (Per mL) PLEASE GIVE 75 ML OF FLUID UNDER THE SKIN ONCE DAILY. #1 1 REFILL. RSG
Butorphanol 10mg/mL Injection C4 10mL (Per mL) IV FOR SEDATION
Please STOP the Onsior at this time. You can continue the Petinic at this time.
Diet & Activity:

Jasper can eat whatever food he would like at home.
Recheck Appointment:
Please make an appointment for Jasper in one week. We will speak tomorrow once his cytology results return and we can stay in touch
depending on how Jasper is doing at home.
Additional Recommendations:
Please monitor Jasper for worsening lethargy, temperature >105.5, inappetence, fast breathing or weakness. Please call if any of these
signs are seen.
As always, if you have any questions about Jasper's progress, please do not hesitate to call SAGE at (408) 343-7243. We have doctors
on staff overnight that can see Jasper on an emergency basis if you have concerns.
Thank you for bringing Jasper to SAGE Centers for Veterinary Specialty and Emergency Care.
Sincerely,
Dr. Ryan Garcia

DVM, DACVIM
Thank you for bringing Jasper to SAGE for work up of his fever and diarrhea. He is a sweet and lovely kitten and we have loved having
him here.
On exam, Jasper had a fever and was dehydrated/lethargic. His blood work in-hospital showed an anemia nd high white cell counts. His
chemistry panel had an elevated globulin level; this can be seen with chronic inflammation or FIP.
Jasper's ultrasound found a coarse liver that could be seen with scarring or possibly, inflammation. He has a wisp of free fluid in his
belly. Jasper's intestines appeared normal though they can appear normal on ultrasound and still have disease present. Jasper's chest
x-rays were normal as was his heart (though his heart is generally large for a cat his size.
We have Jasper on multiple antibiotics for any sort of bacterial infection that could be present driving his fever (full blood and urine were
performed by Dr. Rubin last week). Jasper thus far has failed to have his temperature normalize. We are giving him more time on his
antibiotics though we are concerned that his diarrhea and his fever might be linked and there is concern for FIP in Jasper.
His coronavirus titer is very strongly positive. This on its own does not prove FIP though the higher the titer, the higher the probability of
FIP. We discussed that definitive diagnosis of Jasper's illness would likely entail sampling of his liver an likely intestinal biopsies given his
history of diarrhea.
We cannot definitively rule out that Jasper has two problems (a chronic cause of diarrhea and a fever from an unnamed virus etc).
We discussed that since Jasper is eating well, bright and his temperature is only mildly eleveted, it is OK to try to take him home and
monitor his response to continued antibiotics. We also discussed that if Jasper's temperature remains elevated we may consider adding
steroids to his treatments in case he has FIP (though steroids have risks associated with them). We have included some information on
FIP below (we have a concern for FIP but we have have not confirmed this as the cause of Jasper's signs).
For now, we will see how Jasper does at home into tomorrow and ideally recheck his temperature tomorrow. If he is still feverish, we
may consider adding prednisolone (steroids) as discussed.
We discussed and are again submitting a fecal test on Jasper to look for testable infectious causes that can be found in the feces.
MONITORING:
Please monitor Jasper for worsening lethargy, inappetence, vomiting, progressive diarrhea or not eating/drinking. Please call us if these
signs are seen.
We would recommend checking Jasper's temperature at home. You can do this with a quick read rectal thermometer and some
water-based lubricant. Normal temperature is below 102.5-103.0 F
RECHECK:
We will check in with you tomorrow to get an update on Jasper. We can decide on pursuing other tests or starting steroids for Jasper.
DIET:
Jasper can eat any cat food he wants at home (kitten food is most ideal). You can give him some tuna fish etc to entice him to eat if he
is unwilling to et at home (he's been eating well here).
MEDICATIONS:
Marbofloxacin 25 mg tablets: Please give 1/4 of a tablet by mouth once daily, ideally with food.
____________________________________________________________________
Feline Infectious Peritonitis
About the Diagnosis
Feline infectious peritonitis (FIP) is an extremely serious viral disease that affects cats but not dogs, humans, or any other species. It is
caused by a coronavirus, meaning that it is spread mainly through the digestive tract, and is contracted by cats when they are in
contact with the feces (stool, excrement) or bodily fluids of infected cats. FIP is often fatal in cats, so identification of infected cats and
prevention of contact with other cats that might contract the illness is important.
There are many coronaviruses which infect the gastrointestinal tracts of different animals, and they fall into two broad categories:
enteric coronaviruses, which cause mild, brief signs of digestive upset and are relatively harmless, and mutated coronaviruses such as
the FIP virus. An example in the first category, feline enteric coronavirus, is a virus that is commonly found in cats, is restricted to the
gastrointestinal tract, and does not cause significant illness at all. By contrast, some variants, or strains, of this virus, such as feline
infectious peritonitis virus, fall into the second category, do cause significant illness, and are responsible for FIP. These viral variants are
able to travel out of the digestive tract, through the bloodstream, to other parts of the body where they may persist indefinitely and
cause severe symptoms that can become life-threatening.
FIP is a disease that most frequently appears in young cats from 6 months to 3 years old but can occur in cats of any age. Almost any
part of the body may be affected by the spread of the FIP virus, including the liver, kidneys, nervous system, and eyes.
While coronaviruses in general are highly contagious, the number of exposed cats that actually contract FIP is low. In most cats,
coronaviruses remain confined to the intestinal tract and will not cause FIP. It appears that a combination of virus mutation and a trigger
within the cat (possibly with an underlying genetic component) cause otherwise harmless enteric coronaviruses to transform into FIP
virus. Once a cat has been confirmed to have FIP (which requires analysis of fluid and/or tissue- see below), the possibility of contagion
may exist in the environment and precautions such as separation of an infected cat from other cats, and basic hygiene including
handwashing and litterbox hygiene, are recommended.
Affected cats may have stunted growth and fail to thrive, especially if they develop FIP when they are kittens. They will often be thin
and have a rough, dull hair coat. Two different subforms of FIP are seen, and each produces distinctive symptoms. The "wet" form
causes fluid accumulation in the abdomen (belly) or the chest; abdominal fluid accumulation can give a potbellied appearance that is
often mistaken for intestinal parasites, whereas fluid accumulation in the chest may cause difficulty breathing due to fluid compression
of the lungs. Cats with the "dry" form of FIP may slowly lose weight and have appetite loss, lethargy, and unexplained fever. The onset
of disease is usually very gradual with the dry form. Older cats almost always contract the dry form of FIP. This form of FIP can also
cause a variety of nervous system symptoms, including seizures.
Diagnosis of FIP requires a thorough physical examination, blood tests, and x-rays and/or ultrasound in most cases. Even so, confirming
the diagnosis of FIP is complicated by the fact that blood tests cannot distinguish between harmless, nonpathogenic feline enteric
coronaviruses and the devastating strains that cause FIP. Many normal, healthy cats have been exposed to coronavirus and will test
positive without having FIP. Therefore, conclusions should never be drawn about a cat's health status based on a test for feline
coronavirus alone. Rather, advanced testing such as withdrawal of accumulated fluid from the chest or abdomen with a small needle for
analysis is necessary in virtually all cases. Often the symptoms of the wet form of FIP are distinctive enough that a diagnosis is highly
likely based on these minimally-invasive tests alone. However, positive diagnosis of the dry form of FIP can be a challenge. If there is a
high suspicion that dry FIP is responsible for a cat's symptoms, surgery is often required to obtain biopsy samples from various organs.
Tests (immunohistochemistry) performed on the biopsy samples can confirm the diagnosis, and tissue biopsy, typically of the intestine,
is the gold standard for diagnosis of FIP if any uncertainty remains from the results of less invasive tests.
Living with the Diagnosis
If your cat is diagnosed with FIP, you should prevent his/her coming in contact with new cats since the virus is potentially contagious.
However, there is no need to isolate him or her from other cats in the household with which he or she has already been in contact. All of
the household cats are likely to have already been exposed to the virus, so isolation will not prevent spread of the virus and may, in
fact, have a negative impact on the health of the cats due to the additional stress it causes. Most cats exposed to the virus will not
develop FIP.
Treatment
There is no cure for FIP, and symptoms tend to worsen over days to months until fatal. Therefore, treatment of FIP is aimed at making
an affected cat comfortable. The cat should be encouraged to eat, and stress should be avoided. Treatments with immunosuppressive
drugs, such as corticosteroids, or immunomodulators are often used, but the benefits are limited. FIP is devastating and virtually every
cat with confirmed FIP dies of the disease, although some can live for several months with supportive treatment.
DOs
Be sure that the diagnosis is accurate since FIP is devastating, and false results (false positive or false negative) are common.
If the diagnosis of FIP is confirmed and your cat is showing symptoms of illness such as loss of appetite, tempt your cat to eat with his
or her favorite foods.
Avoid stressful situations for the cat (unnecessary transport, extremes of temperature, etc.), which can allow the disease to worsen.
Consult your veterinarian for information on other supportive treatments that may be appropriate.
DON'Ts
Do not allow your cat to roam outdoors or otherwise have contact with uninfected cats, to help prevent spread of the virus.
When to Call Your Veterinarian
When treating a cat that has had FIP confirmed:

If your cat will not eat or drink or becomes extremely debilitated.
If your cat develops rapid, shallow breathing or begins to breathe through its mouth (panting like a dog), which is abnormal in cats
(exceptions: when traveling or when the weather is hot, in which case even healthy cats may pant).
Signs to Watch For
As signs warranting an immediate recheck, including after hours/emergency:
Rapid, difficult breathing or open-mouth breathing. This can be a sign of fluid buildup around the lungs and is an emergency. Be
careful to not stress your cat if it shows these signs, but rather telephone the veterinary hospital and proceed calmly.
Additional Information
Cats diagnosed with FIP usually live in, or have originated from, multiple-cat households (more than 5 cats) or breeding catteries.
Breeders and owners of multiple cats should consult their veterinarian for more information on the control of FIP in these situations.
A vaccine is available for FIP. However, it is not generally recommended for household cats and has not proved to be very effective in
preventing the disease.
Vet Communication
SAGE Centers Campbell

907 Dell Avenue
Campbell, California, 95008
Ph: (408) 343-7243
Fax: (408) 385-3680
Email: Campbell@SageCenters.com
Dear Dr. Rubin,
Please find attached the case summary for "Jasper" Grant, owned by Sylvaine & Adam Grant. "Jasper" was recently seen by our SAGE
Centers Campbell service. Please contact SAGE Centers Campbell at (408) 343-7243 if there are any questions or concerns, and thanks
again for having us be part of Jasper's health management team.
Take care,
Dr. Ryan Garcia
Please note this email address is automatically generated. Please do not reply.
CONFIDENTIALITY NOTICE: Information contained in this message and any attachments is intended only for the addressee(s). If you
believe that you have received this message in error, please notify the sender by calling (408) 343-7243, and delete it without further
review, disclosure, or copying. Thank you.

907 Dell Avenue
Ph: (408) 343-7243
Fax: (408) 385-3680
Dear Dr. Rubin,
Centers Campbell service. Please contact SAGE Centers Campbell at (408) 343-7243 if there are any questions or concerns, and thanks
again for having us be part of Jasper's health management team.
Take care,
Dr. Ryan Garcia

907 Dell Avenue
Ph: (408) 343-7243
Fax: (408) 385-3680
Dear Colleagues,
Centers Campbell service. Please contact SAGE Centers Campbell at (408) 343-7243 with any questions or concerns. Thank you for
having us be part of Jasper's care.
Regards,
Dr. Christine Wong

DVM, DACVECC

907 Dell Avenue
Ph: (408) 343-7243
Fax: (408) 385-3680
Dear Colleagues,
Centers Campbell service. Please contact SAGE Centers Campbell at (408) 343-7243 with any questions or concerns. Thank you for
having us be part of Jasper's care.
Regards,
Dr. LeAnne Jain

DVM
Hospital Notes
Urine and BM in litter. Removed e-collar and offered 1/4 can own wet, pt ate all, then ate own kibble remaining in cage. SC
Meowing/yowling when urinating
Elevated temp again, urine =4+, changed box. Gave Unasyn 3.4ml IV over 30 minutes -AS
Urine =4+, changed box. Offered fancy feast, appetite =2+ -AS
pt lost his patients while obtaining temp, unable to get heart rate. offered own kibble and wet, pt has 0 int.
Lt pink
DTorres- P is quiet/depressed. He did fine for his vitals except his rectal temp. He was growling and fearful. Tmep was 103.7. 0 voids on
bed or in litter box. IVC patent
Image Attachments
SAGE welcomes three new doctors! Dr. Rory Applegate has joined our Concord and Dublin Internal Medicine teams; Dr.
Zuhal Elhan has joined our Dublin Emergency team, and Dr. Shyla Myrick has joined our Campbell Emergency team.

Sage ClinicalSummary AN268826 S10460

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CLINICAL SUMMARY

Client Details Patient Details

Recheck in 1 week. 1/23/18 603p DJD,ca

WB rads were normal per O

Today's weight was 1.85 kg (1.72 kg 1.8 kg).

1. Metronidazole susp 50mg/mL: 0.4mL PO BID

Diet: Veluva mostly, variety of wet food, added pumpkin

Persistant diarrhea and lethargy

Neurologic examination ﬁndings:

Neuroanatomic localization: T3-S3

1700h: QAR, standing at cage front. MM: Pale pink, eupneic.

BAR, nervous kitty.

Appearance: Quiet alert responsive and 5-6% dehydrated, lethargic

Spleen: Moderate lymphoid reactivity.

FeCoV ICC to LN at VDx.

Plan recheck in one week.

Chem: Glob: 6.2, BUN: 15, Creat: 1.3, remaining WNL.

Consider fenbendazole trial (declined at this time)

Owners attempting novel/select protein diet (Rabbit; OTC)

If persistent diarrhea and biopsies declined, consider prednisolone.

Clavamox 62.5 mg/ml: D/C at this time.

Marboﬂoxacin 25 mg tablets: D/C at this time.

Consider fenbendazole trial.

Consider attempting novel/select protein diet.

Send home novel protein diet (owner is unlikely to feed).

CBC/Chemistry/Lytes- HCT 22%, Neut 17,000, mono 1300

Transfer to IM for AUS and additional diagnostics.

Shyla Myrick MBA, DVM

Ultrasound Guided Aspirate

SAGE In-House Non Integrated Diagnostics

Immunocytochem-VDx (1st stain)

VDx Veterinary Diagnostics

Cytology VDx - Body Fluid (3 sites) (Ref: US10460-DR46983)

Grant, Sylvaine & Adam

412 Cedar St. Suite D, Santa Cruz CA 95060

Pyrexia, diarrhea in October. Chronic weight loss, elevated globulins, lethargy.

Scant hypoechoic peritoneal and dorsal retroperitoneal ﬂuid.

Hypoechoic liver, splenomegaly, lymphadenopathy, and peritoneal eﬀusion have diﬀerentials of

infectious process (such as FIP) or neoplastic inﬁltrate (such as lymphoma).

Eric Garcia, DVM

Test Results Unit Lowest Value Highest Value Qualiﬁer

Test Results Unit Lowest Value Highest Value Qualiﬁer

Test Results Unit Lowest Value Highest Value Qualiﬁer

Test Results Unit Lowest Value Highest Value Qualiﬁer

PCV/TS (In House) (Ref: US10460-DR46842)

Test Results Unit Lowest Value Highest Value Qualiﬁer

Ultrasound - Inpatient Recheck (Ref: US10460-DR46690)

Ultrasound - Abdomen (Ref: US10460-DR46507)

Test Results Unit Lowest Value Highest Value Qualiﬁer

URINALYSIS(910) (Ref: US10460-DR9453)

Test Results Unit Lowest Value Highest Value Qualiﬁer

CHEM 25 w/ SDMA(111) (Ref: US10460-DR9453)

Test Results Unit Lowest Value Highest Value Qualiﬁer

T4(804) (Ref: US10460-DR9453)

Test Results Unit Lowest Value Highest Value Qualiﬁer

CBC COMPREHENSIVE(300) (Ref: US10460-DR9453)

Test Results Unit Lowest Value Highest Value Qualiﬁer

Ultrasound - Inpatient Recheck (Ref: US10460-DR9447)

Clinic Notes / Speciﬁcs

FECAL O&P + GIARDIA

FELINE DIARRHEA PANEL COMP

AV Vmax (m/s): 1.41

Clinic Notes / Speciﬁcs

AV Vmax (m/s): 1.41