My Cat has Hepatic Pelios - Rare - Please HELP!!

Hi, 

I have taken my cat back and forward to the vets for all sorts of tests recently including a liver biopsy (results below).  My vet is wonderful but says that he  has never seen this disease in cats, it is so rare they have no idea how to help or medicate.  He is obviously researching along with pathologist at the practice.  I'd be so grateful if anyone has every heard of this in cats, how it can be treated or managed.  I love my cat dearly and want the best for him!  Hoping you can help!

Thanks!!

Hannah 

Brian the cat

Feline: Male

Age: 6

Biopsy Diagnosis:  HEPATIC PELIOSIS

Histology:

The sample submission is three portions of liver tissue as biopsies from the cat.  Clinically there is mils hepatomegaly with hyperechoic foci on ultrasound.  Cat has history of intermittent head tremor.

The sections of the liver samples show recognizable lobular architecture with portal and central vein areas.  Some hepatocyte swelling with hydropic change.  However, in the subserosal and parenchymal areas there is mutlifocal rough cystic cavity formations as distention of sinusoids, blood filled spaces retaining partial lining of vascular endothelium.  There is a minor accumulation of blood derived products in swollen hepatocytes or macrophages.  A few clusters of lymphocytes are also noted

Comment:

A histological presentation suggestive of HEPATIC PELIOSIS, a vascular disorder of uncertain aetioligy in cats.  Focal obstruction of small branches of portal veins has proposed to initiate this reaction.  The functional significance is uncertain and perhaps would depend on how widespread condition throughout the organ.

Other info:

* It was picked up after doing deductive blood tests after taking him to the vets to discuss head tremors that appeared to happen when relaxed - not long lasting, some time just a few seconds but tremors were definitely involuntary.

* First blood tests showed that his liver enzyme levels were normalish (55-66) when starved but over 120 after having eaten (bile acid test),  Kidney function appeared normal.  Urine tests we're clear.

*The vet commented that when he did the biopsy that his whole liver was very unhealthy and appeared mottled and swollen across the whole surface area.  The surgery took an hour longer than anticipated due to having to stop the bleeding on his very damaged liver.  However, he has fully recovered from his surgery now and is happy and playful.

* After surgery, PCV tests showed that count was at 24 (normal 26-46), its raised within 4 days after having 4 tests over this period to ensure no internal bleeding. It is currently at 26 still.

* He has a lost a little bit of weight but is eating and drinking normally.

Welcome to TCS. I wish it were under better conditions. I have no knowledge of this disease, but hope that your vet can come up with something to help.

Thank you! I hope they come up with something too! Gutted!!

Hmmm... dunno if my experience will give you any ideas, but here goes.

One of my cats, Pippen, became very ill in '08, he was throwing up constantly, not keeping anything down, and losing a lot of weight because of it.

First round at with vets, they found him to be severely constipated, literally blocked up to his stomach.  Over the course of 2 weeks, he ended up going in for 5 enemas.  Finally, we seemed to get everything cleared out.  But he still wasn't eating well.

Second round with the vets, they tested him for pancratitis.  Those tests came out negative.  In the meantime, his ALT was climbing, and he was still not eating well and continuing to lose weight.

Finally, we went in for a full liver biopsy.  When the vet came to tell me what they found, she was not very optimistic.  His liver was covered with little bumps and nodules, and she suspected cancer.  She sent the samples out for confirmation.  The following week was torture.  All I could think was, "How the hell does a 4 year old cat end up with liver cancer?!"  That's when I really started looking into foods, and eventually I made the decision to feed my animals a more species appropriate diet. 

Finally the results came in, and it was a bit of a surprise.  Those bumps and nodules were actually new growth.  The liver is the only organ that can actually repair itself, and his was desperately trying to do just that.  The biopsy showed that he had a tenacious bacteria in his liver, and his liver was very badly scarred. 

Then my vet did another test to check the bile flow, and low and behold, his bile was flowing the wrong direction, and backing into his liver.  Recalling the constipation and enemas, all I could think was, "Gee, I wonder how that happened?"  So, basically, his liver was being attacked on two fronts, bile and bacteria.

We hit the bacteria with a series of antibiotics, and gave him medicine to help the bile flow in the proper direction.  We also gave him liver supplements, to help the liver in it's own regenerating efforts.

Currently (5 years later), Pippen is still taking Ursodiol to keep the scarring down, and Sam-e (s-adenosyl) and Milk Thistle (silymarin) as liver support supplements.  His ALT is still a little high, but I suspect it will never be "normal".

I understand your diagnosis is quite a bit different, but perhaps these supports would be beneficial.