14 Vetcom Volume 57 CONTRIBUTING AUTHORS | FEATURED CASE A Heidi Ward, DVM, ACVIM (Oncology) Contributing Author: eosinophilia 22,945/ul. the CBCrevealed apersistentleukocytosis (35,300/ul) withmarked within themid-abdomen anddiffuse splenomegaly. The resultsof were normal;abdominalradiographs revealedanincreasedopacity and abdominalultrasoundwere performed. Thoracic radiographs detected. A repeatCBC,profile, thoracicandabdominalradiographs later. Onphysicalexaminationapalpableabdominal masswas was seenandreferredfor furtherdiagnosticworkup2weeks acid, FenbendazoleandMetronidazole howevernoimprovement started ontherapywithPyrantelpamoate, Amoxicillin/Clavulanic (14,175/ul) andmonocytosis(1,260/ul). The catwassubsequently ul consistingofamatureneutrophilia(12,915/ul),eosinophilia found uponinitialworkupwasaperipheralleukocytosisof 31,500/ Featured Case FIV, CBC/ProfileandHeartwormtests. Theonlyabnormality loss. Previousdiagnosticsincludedafecalfloatation,FeLV/ history oflethargy, anorexia, vomiting,diarrheaandweight 6 yearoldMaleneuteredDSHpresentedwitha1month IN A CAT

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CONTRIBUTING AUTHORS | FEATURED CASE 15 EOSINOPHILIA IN A CAT IN EOSINOPHILIA CBC Smear CBC Results CBC Marked Peripheral Eosinophilia. 16 Vetcom Volume 57 CONTRIBUTING AUTHORS | FEATURED CASE with nucleardiametersreangingfrom12-15micronswerenoted. Nucleated cellsconsistedprimarilyofeosinophilsfoundindividuallyandingroups.Occasionalfoamymacrophages afewapicalroundcells EOSINOPHILIA INACAT dexamethasone 4mgSQandreleased on Prednisone5 declined bythe owner. The catwassubsequentlygiven the atypicalcellsandruleout underlyingneoplasiawas resection oftheintestinalmass andtofurthercharacterize An exploratorylaparotomy todeterminefeasibilityof associated eosinophiliawas made. syndrome orintermediate cell lymphomawithtumor eosinophilia, adifferential diagnosesofhypereosinophilic intestinal mass,atypicallymphocytesandperipheral In lightofthepresenceaneosinophilicinflammatory nucleoli andscantamountsofdeeplybasophiliccytoplasm). (ie roundnuclei,coarselygranularchromatin,prominent had featuresconsistentwithatypicalmediumlymphocytes ranging from12-15umwerealsopresent. These cells and afewatypicalroundcellswithnucleardiameters individually andingroups.Occasionalfoamymacrophages a predominantpopulationofeosinophilsfoundboth of theintestinalmasswasperformedwhichrevealed lymphadenopathy wasdetected. A fineneedleaspirate wall thickeningwithluminalnarrowingwasseen.No focal poorlyechogeniccircumferentialsmallintestinal On ultrasonographyoftheabdomen,a2.7x1cm Cytology ofIntestinalMass contained plump fibroblastswhichmarkedly distortedand broad interconnecting trabeculaeoffibrous tissuethat plasma cellsandfewermacrophages. There werealso eosinophils intermixedwith fewermastcells,lymphocytes, replacement ofnormalarchitecture withlargenumbersof for histopathology. The lymphnoderevealedinfiltrationand splenomegaly weredetected andsamplesweresubmitted At necropsy, mesentericlymphadenopathy and declined andhumaneeuthanasiawaselected. lymphadenopathy andsplenomegaly. Furthertherapywas evidence ofintestinalthickening,multifocalmesenteric ul witheosinophilia29,610/ul.Ultrasonographyrevealed anemia andrecurrenceofmarkedleukocytosis65,800/ and anorexia. A repeatCBCrevealedanonregenerative mg q12hr. 3monthslaterthecatrepresented forvomiting splenomegaly. The catwascontinuedonPrednisone5 75% withnoevidenceofmesentericlymphadenopathy or revealed areductioninsizeoftheintestinalmassby had resolved(870/ul)andultrasonographyoftheabdomen 2 weekslater, thecathadgained½pound,eosinophilia owner subsequenttosteroidswithin48hours.Onrecheck mg q12hr. Nofurthervomitingordiarrheawasseenbythe

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11 EOSINOPHILIA IN A CAT IN EOSINOPHILIA The term FGESF was first proposed and 16,17 4,5,6,7,8,9,10 evaluation of reveals prolonged, persistent marked prolonged, persistent of blood reveals evaluation marrow is forms and the bone with immature eosinophilia of and maturation differentiation by a disordered dominated eosinophils. described in 25 cats by Craig et al in 2009.4 In this subset described in 25 cats by Craig et al in The organs most commonly infiltrated with eosinophils in commonly infiltrated with eosinophils The organs most spleen, gastrointestinal tract, marrow, HES include the bone but any organ can be nodes and liver, mesenteric lymph and mortality is due to In humans, most morbidity affected. Clinical signs of HES are nonspecific cardiac involvement. and include diarrhea, organ(s) affected and vary with the pyrexia and pruritus. HES is typically weight loss, anorexia, fatal disease. Management but not always a progressively consists of lifelong therapy with corticosteroids. Prednisone is started at 4-6 mg/kg /day for at least one Prednisone is started at 4-6 mg/kg mg/kg every 24 to 48 month then gradually tapered to 1-2 CBCs and careful hours. Monitoring consists of repeating abdominal palpation with imaging. include Causes of Intestinal eosinophilic antigens, fungi, parasites, , food or environmental herpesvirus. Eosinophils gondii and Toxoplasma oomyctes, mediators such have been shown to produce numerous A unique IL-1b which play a role in fibrosis. TGF-B and as appears to be limited form of a feline eosinophilic lesion that lymph nodes has to the gastrointestinal tract and regional Eosinophilic Fibroplasia been termed Feline Gastrointestinal (FGESF). 3

2 Peripheral eosinophil counts in 12,13,14,15 Increases up to 5,000/µL are considered mild, are Increases up to 5,000/µL 1 cats with HES range from 3,500/uL to 130,000/uL and the to 130,000/uL cats with HES range from 3,500/uL The distinction between an eosinophilic cells appear mature. syndrome remains leukemia and idiopathic hypereosinophilic when serial elusive. Eosinophilic leukemia is diagnosed Hypereosinophilic syndrome (HES) is a disorder Hypereosinophilic syndrome (HES) eosinophilia and characterized by a persistent peripheral eventually cause organ infiltration by eosinophils, which in cats and its organ failure and death. It occurs primarily origin is unknown. In cats, eosinophilia is defined as an absolute increase in is defined as an absolute increase In cats, eosinophilia eosinophils of more than 800/ the number of circulating ul of blood. expanded the lymph node. These changes have been seen have been seen These changes the lymph node. expanded sclerosing eosinophilic with gastrointestinal in association was that the red pulp The spleen revealed fibroplasia. eosinophils numbers of well differentiated infiltrated by large syndrome. suggestive for hypereosinophilic up to 10,000/µL moderate and over 20,000/µL marked. and over 20,000/µL moderate up to 10,000/µL of diseases associated with eosinophilia General categories infectious diseases, hypersensitivity include parasitic and In infiltrative diseases, and neoplasia. disorders, eosinophilic eosinophilia only cats a retrospective study of 312 cats with disease, focal with flea allergy dermatitis, gastrointestinal and miscellaneous inflammation/eosinophilic granuloma over 10,000/ul. dermatopathies had eosinophil counts Paraneoplastic eosinophilia has been reported in association Paraneoplastic eosinophilia has been lymphoma, T-cell with mammary tumors, leiomyosarcoma, urinary bladder tumors. fibrosarcoma, mast cell tumors and 18 Vetcom Volume 57 CONTRIBUTING AUTHORS | FEATURED CASE 56% oftheircaseshoweverantibioticswerenotaclinically initiation oftheinflammatoryresponseandweredetectedin Craig etalpostulatethatbacteriamayberesponsibleforthe eosinophils areseen. matrix, fibroblastsandeosinophilshoweverinsomecasesonly eosinophils. Cytologicalfindingsmayrevealaneosinophilic histologic findingofdensecollagentrabeculae,fibroblastsand expanding thewallofsiteaffected withacharacteristic The typicalappearanceofFGESFisthatanulceratedmass historical andphysicalexaminationfindings. and apalpableabdominalmassappeartobethemostcommon was acommonfindinginbothstudies. Vomiting, weightloss reported byLintonetalin2015. detailing 13caseswithsimilarhistologicfeatureshasalsobeen (36%) andsmallintestine(16%). A subsequentretrospective at thepyloricsphincter(48%),ileocecocolicjunctionorcolon of cats,gastrointestinalinvolvementwasmostcommonlyseen EOSINOPHILIA INACAT fibroblasts whichmarkedlydistortandexpandthelymphnode. interconnecting trabeculaeoffibroustissuethatcontainplump plasma cellsandfewermacrophages.Therewerealsobroad of eosinophilsintermixedwithfewermastcells,lymphocytes, The lymphnodeisinfiltratedandreplacedbylargenumbers Lymph NodeHistopathology J. 2015Nov;62(6): 356-60 eosinophilic sclerosing fibroplasiamimickingmetastatic neoplasia,NZV 8. Munday, JS.,Martinez, AW., Soo,M., A castoffelinegastrointestinal march 1;238(5):585-7 7. Sihvo,Simola,Vainionpaa, Syrja,PathologyinPractice,JAVMA, 2011, fibroplasia, JFelineMedSurg.2015 May;17(5):302-404 NS, Wright, M.,Malik,R., FelineGastrointestinaleosinophilicsclerosing 6. Linton,M.,Nimmo,JS.,Norris, JM.,ChurcherR.,Haynes,S.,Lessels, and prominenteosinophilinfiltrationincats, Vet Pathol40:283-287(2003) I., Absess-forming inflammatorygranulationtissuewithgrampositivecocci 5. Ozaki,K., Tamagami, T., Nomura,K.,Haritani,M., Tsutsumi, Y., Narami, pathol 200946:63 Moore, R.R.,FelineGastrointestinalEosinophilicSclerosingFibroplasia, V 4. Craig.L.E.,Hardam,E.E.,Hertzke,D.M.,Flatland,B.,Rohrbach, B.W 2012 Hypereosinophilic Syndromeinacat,JVet. Med.Sci.74(8)1057-1062 K., Nakayama,H., Tsujimoto, H.,Intestinal T-Cell Lymphoma withSevere 3. Takeuchi, Y., Takahashi, M., Tsuboi, M.,Fujino, Y., Uchida,K.,Ohno, Cats, JAAHA,v.26, p. 2. Center, S. A., Randolph,J.F., Erb,H.N.,Reiter, S.,1990,EosinophiliaIn Kenneth Latman 1. Duncan,Prasse,2014,Veterinary LaboratoryMedicine,editedby References 6 Regional lymphadenopathy Regionallymphadenopathy ., et et eosinophils. The redpulpwasinfiltratedbylargenumbersofwelldifferentiated 1004-1008 Can Vet J.Sep2011; 52(9) 17. Gilroy, Forzan,Drew, Vernau, Eosinophiliainacatwithacuteleukemia, leukemia inacat,Vet ClinPathol.December2006;35(4):454-9 16. Gelain, Antoniazzi, Berazzolo, Zaccolo,Comazzi,Chroniceosinophilic hypereosinophilic syndrome 15. Saxon,Hendrick,Waddle, Restrictivecardiomyopathyinacatwith Comp Med1985;59:248-253 14. McEwen,Calli,Hulland,Hypereosinophilicsyndromeincats,Can J CanVet JVolume 37, Nov1996 13. Wilson, Thomson-Kerr, Houston,Hypereosinophilicsyndromeinacat, Leukemia, J An Anim Hosp Assoc. 1994Nov-Dec;30(6):591-23 12. Huibregtse, Turner, HypereosinophilicSyndromeandEosinophilic of Hematology80:148-157(2005) 11. Wilkins,Crane,Copland,Williams,HypereosinophilicSyndrome, Am J. phycomycetes, JCompPathol.2014Nov;151(4):318-21 of felinegastrointestinaleosinophilicsclerosingfibroplasiaassociated with 10. Grau-Roma,Galindo-Cardiel,Isidoro-Ayza, Fernandez,Majo, A case sclerosing fibroplasiainfourcats,J.FelMed&Surg.,2012;15(2)148-154 and clinicopathologicalfeaturesoffelinegastrointestinaleosinophilic 9. Weissman, penninck,webster, hecht,keating,Craig,Ultrasonographic not anoption. agents shouldbeconsideredincaseswhichsurgeryis alone orincombinationwithotherimmunosuppressive quality oflifealbeittemporarilyandthereforesteroids prednisone alonewashelpfulinprovidinganimproved surgically accessibletocompleteexcision. pyloric involvementasthoseinthelattergroupareless masses appeartohavelongersurvivalsthanthosewith of thelesionascatswithileocecocolicorcolonic variable andmaybeassociatedwiththeinitiallocation antibiotics alone.PrognosisforcatswithFGESFis survival timesthanthosetreatedwithsurgeryand feasible) incombinationwithprednisonehadlonger with completeexcisionoftheirlesions(incaseswhere et alrevealedthepresenceofbacteria.Catstreated 69% ofcatsintheretrospectivereportedbyLinton description bacteriawerefoundin100%whereasonly et al2003,of27catswithlesionssimilarhistologic effective treatmentmodality. InanotherstudybyOzaki Spleen Histopathology 4 Inthiscat,