Patient Info:
• Species: Feline (Birman/European Mix)
• Age: 10-11 years old
• Weight: Significant muscle wasting on back/hindquarters.
• Diagnosis: Hyperthyroidism (TT4: 5.72 µg/dL in March).
• Current Meds: Felimazole (Thiamazole), Doxycare (Doxycycline) for the last 2 weeks. Previously completed a course of Cladaxxa (Amoxicillin/Clavulanic acid).
The Core Issue:
Despite a month of various antibiotics, my cat has a persistent "rattling" sound in her chest. Her white blood cell count is not just high—it is steadily rising despite treatment. She has tachycardia (very strong/fast heartbeat) and occasional vomiting (specifically on an empty stomach or with dry food).
Blood Work Progression:
• March 19 (Baseline - No antibiotics yet): WBC: 72.28 K/µL | Eosinophils: 17.88 K/µL
• April 7: WBC: 61.37 K/µL | Eosinophils: 18.10 K/µL
• April 18: WBC: 77.46 K/µL | Eosinophils: 20.20 K/µL
• May 4 (Latest): WBC: 86.74 K/µL | Neutrophils: 59.04 K/µL | Eosinophils: 18.55 K/µL
(Reference WBC: 2.87 - 17.02 K/µL)
Imaging Results:
• Chest X-Ray (March 20): Mixed broncho-interstitial lung pattern. Presence of fluid in interlobar fissures (pleural thickening/effusion). Diagnosis: Chronic pleuropulmonary inflammation (Bacterial, viral, parasitic, or fungal).
• Abdominal Ultrasound (March 26):
• Intestines: Thickening of the muscularis layer (0.18cm). Suspected IBD or Intestinal Lymphoma.
• Kidneys: Left kidney atrophy (2.3cm) with a 0.3cm renal stone (calculus). Right kidney normal.
Recent Treatment:
She was recently dewormed with Evicto (Selamectin). She currently tolerates wet food (Gastrointestinal diet) but vomits dry food.
Questions:
- With WBC rising from 72k to 86k while on Doxycycline, is it likely we are dealing with an antibiotic-resistant infection, or does the high Eosinophil count (18k+) point more toward a severe parasitic (Lungworm) or autoimmune (Feline Asthma/Bronchitis) issue?
- Is Selamectin (Evicto) sufficient for lungworms (Aelurostrongylus), or should we discuss something stronger like Moxidectin or Emodepside with our vet?
- Given the "fluid in fissures" on the X-ray and the 86k WBC, how high is the risk of pleural effusion becoming a respiratory emergency?
- With the intestinal thickening (suspected IBD/Lymphoma), could the systemic inflammation be coming from the gut as well as the lungs?
- How should I balance the Hyperthyroidism treatment (Felimazole) with such extreme systemic inflammation?