Eosinophillic Granuloma Help

My dad (retired veterinarian) has a kitty who has severe Eosinophillic Granuloma on his face/mouth.  The only thing that keeps it at bay (never healed) is high dose prednisolone every other day.  He has tried the limited diets and nothing seems to help him.  I recently read that Lysine may help so he is adding that to Petey's treatment as well.  Does anyone have any other ideas on what he can do to help him?  Sometimes he gets sores on his back legs but mostly it's his upper lips.

I've seen people attempting to treat EGC with prednisolone before on the forum......also without success.

The preferred drug is a long acting corticosteroid, Depomedrol.

The "trick" is to suppress the immune response long enough for the lesions to heal up.

That said, there are other conditions that mimic EGC....top notch treatment,  therefore, also involves a biopsy sent off to a lab.

If your dad wasn't able to determine the cause, it's quite possible that it may have been a transient allergen that set things going - or, that it's the immune system itself causing it (more about that in a link I'm giving you).

My Blaize had an outbreak on his chin several years ago - one of spurious origin. A quick surgery to 'clean things up' a little, take the sample and a single shot of Depo - presto - we haven't seen it since.

I have 2 links for your dad, the first is a concise summary of traditional treatment, the second, quite a novel one!

Post back so that we hear the followup to this.

Here you are:

1. http://www.marvistavet.com/html/eosinophilic_granuloma.html
2. http://www.omeopatia.org/upload/Image/my_operatori/CGE .pdf

Our last cat had EGC, and his first flare up was successfully treated with Depo. After that I gave him salmon oil every day during a flare, and once or twice weekly for maintenance, which worked. Back then some people whose cats had severe EGC were using feline birth control pills. I don't remember the details, but that might be something to look into. The EGC forum I belonged to is now defunct, but there's probably still a yahoo group or something similar.

The salmon oil dosage was 500 mg. a day squeezed over his food, which the vet okayed. Jamie got rodent ulcers, not the severe form with plaque on other parts of his body. We determined through blood testing that he was allergic to beet pulp and soy, which were common in cat food then.

jcat said:

Back then some people whose cats had severe EGC were using feline birth control pills. I don't remember the details, but that might be something to look into.

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Hi jcat !

Female hormone therapy was once used....that's long been discontinued due to the serious inherent side effects risks. All that is covered off in the MarVistaVet article I referenced:

Female hormones (such as Ovaban^{[emoji]174[/emoji]} tablets and Depoprovera^{[emoji]174[/emoji]}  injections) were once widely used for this condition but are now considered inappropriate due to side effect potential (they can cause diabetes mellitus, pyometra, and can raise the risk of mammary cancer). 

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The salmon oil probably served as an anti-inflammatory agent......nowadays, Krill oil is seen to be more effective in that vein.

It doesn't surprise me - that was a decade ago.I'll take a look at the articles when I'm at a computer.The Omega 3 & 6 were what helped. If krill oil has more, all the better.

Some of the cats being treated with hormones had lesions on their internal organs, so their owners probably figured the risks of side effects were worth taking at the time. I was grateful Jamie "just" got rodent ulcers and the salmon oil worked after seeing some of the photos posted and reading people's accounts.

He has tried Depo Medrol with no success. He did have it biopsied so he does know for sure what he is dealing with.  I will pass along the information to him.

@White Shadow I found that article about the Snake remedies a few years ago, we tried the Lachesis with little response.

Lysine won't hurt him.  I'd give 1000mg a day (500mg twice daily) when he's got the flare ups and then back down to maintenance dose when he doesn't.  Maintenance dose is 500mg a day (250mg twice daily).  It's important that you give it twice daily so that it stays in his system.  Also, you can try pure Evening Primrose Oil.  I know of some owners who've had great success with it. The dose is 500mg daily.  You can get the capsules, prick a hole in one end & squeeze the oil out onto wet food.  Be sure it's pure evening primrose oil like this one.  https://www.swansonvitamins.com/swanson-efas-evening-primrose-oil-omegatru-500-mg-250-sgels

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cprcheetah said:

 
He has tried Depo Medrol with no success. He did have it biopsied so he does know for sure what he is dealing with.  I will pass along the information to him.

@White Shadow I found that article about the Snake remedies a few years ago, we tried the Lachesis with little response.

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Well then, your Dad is further along into dealing with this than it first appeared...in which case, I certainly wouldn't be second-guessing him.

So, I'll put myself in the position of:  what if the cat were mine?

When Blaize was treated, I was cautioned that there was a possibility more than one 2-week course of Depo would be needed and I was told to monitor the healing process like a hawk - which I did, particularly in the second week and immediately thereafter...I know there was a followup visit scheduled, a recheck, but I can't remember how long after the initial Depo that might have been. The MarVista article speaks to 'stubborn' EGC:

 A more aggressive steroid course (such as the well published protocol of three depomedrol injections given two weeks apart)

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Then, there are several other options listed for consideration there including combinations with certain specific antibiotics.

I would be insisting that my Vet consult with an immunologist at one of the Vet Colleges - the best of these is to be found at the more prestigous schools.

I'd personally be searching for what  jcat mentioned:

jcat said:

The EGC forum I belonged to is now defunct, but there's probably still a yahoo group or something similar.

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The value of these Yahoo support groups, in my experience, is 'blown off' by the Vet community and largely unknown in the pet community....but, the combined experiences of (usually) hundreds (if not thousands) of global members is priceless.

And - remember the Krill oil!

The Winn Feline Foundation has been funding and reporting on many immune-condition-related research projects (you can keep on top of these by subscribing to their announcements and blog updates) - I'll offer to do a little searching for you.

Hope some of that will help.

I've looked around on the Winn Foundation site but found nothing. I've sent an inquiry asking about current and previous projects.

Their site does indicate that their researchers use PubMed to publicize findings....there are about 25 total published studies there: http://www.ncbi.nlm.nih.gov/pubmed/?term="eosinophilic+granuloma+complex"

Interestingly, I learned that EGC isn't restricted to felines...there's an organization to support rare human cases as well: http://histio.org/page.aspx?pid=395

When I hear back from Winn, I'll post.

How about Duralactin? (http://www.duralactin.com/feline-capsules.html)

I only just recently came across this product during a research frenzy, and have found testimonials that it helps cats and dogs with a variety of inflammatory conditions, such as arthritis, IBD, cystitis, etc. The company claims that an allergic reaction to the main ingredient is possible, but rare.

I also found this on JustAnswer in which the vet says that Duralactin has had 50% success in her EGC cases:

http://www.justanswer.com/cat-health/81e9f-holistic-treatments-granuloma-cat-whose.html

My cat has a suspected granuloma on her tongue. It was huge! The first vet who looked at it swore it was cancer and told me to take her to the university (which would cost thousands). I took her to a second vet, who looked at her and said "lets try depo shots every 2 weeks".  She is due on Thursday for her second shot and I am hopeful as the lump is now 1/2 the size it was.  It is shrinking!

If it was cancer of the mouth, it would be non operable. My vet didn't want to biospy it as the tongue is easily infected and then the cat won't eat.

I do wonder if antihistamines will work if it is an allergic condition? I really haven't had a chance to research it further...  I think the steroid shots are the way to go... at least for now. I do worry about  long term use.

Keep researching it...

Quote:

White Shadow said:

 
I've looked around on the Winn Foundation site but found nothing. I've sent an inquiry asking about current and previous projects.

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Just an update on that  for you,  cprcheet :  I received a very welcoming reply from Winn. They will look into this over the next few days...they have over 40 years of research 'under their belts'.

I also found several cases of EGC addressed by Dr. Mike Richards, a very respected Veterinarian - read carefully, he talks about many treatment modalities - you'll find them here:  Vetinfo.com - Eosinophilic Granuloma Complex

Sarah Ann said:

 
I do wonder if antihistamines will work if it is an allergic condition?

I think the steroid shots are the way to go... I do worry about  long term use

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Hi Sarah Ann !

If you read through the last link I posted above you'll find that both of those issues are addressed.

Sarah Ann said:

 
My cat has a suspected granuloma on her tongue. It was huge! The first vet who looked at it swore it was cancer and told me to take her to the university (which would cost thousands). I took her to a second vet, who looked at her and said "lets try depo shots every 2 weeks".  She is due on Thursday for her second shot and I am hopeful as the lump is now 1/2 the size it was.  It is shrinking!

If it was cancer of the mouth, it would be non operable. My vet didn't want to biospy it as the tongue is easily infected and then the cat won't eat.

I do wonder if antihistamines will work if it is an allergic condition? I really haven't had a chance to research it further...  I think the steroid shots are the way to go... at least for now. I do worry about  long term use.

Keep researching it...

Click to expand...

The thinking is that it is due to an allergic response for the most part (from what I have researched)  I have read that Zyrtec (1/2 tablet once a day) has worked in some cases.  It did not work in my dad's cats case.  Leave it to a Vet's cat to have a troublesome case lol.  He also has a standard poodle that not even the internists can figure out what's causing his bloody noses.  So he has some special animals in his home.

So update on my dads cat.  He has been using the Lysine for about a month now and the cat is showing some slight improvements.  He is probably going to try the Duralactin next.  I feel so bad for the kitty his lip looks so painful.

My cat has EGC and it is very aggravating. We have tried the natural food diet but it wasn't a food allergy. We are sure What is causing her flare ups. We are curcurrently using omega 3 chews. It is too soon to tell. We just started this treatment 10 days ago I'm looking for suggestions on What We can do about the itching. She keeps digging at the lesions creating bald spots and making them bigger. She won't leave them alone long enough to heal. The vet wants to give her shots every 3 months but I would rather use a more holistic treatment. Anyone have any ideas?

Not sure What is causing the flare ups is What I meant.

tjsbabyblt said:

My cat has EGC and it is very aggravating. We have tried the natural food diet but it wasn't a food allergy. We are sure What is causing her flare ups. We are curcurrently using omega 3 chews. It is too soon to tell. We just started this treatment 10 days ago I'm looking for suggestions on What We can do about the itching. She keeps digging at the lesions creating bald spots and making them bigger. She won't leave them alone long enough to heal. The vet wants to give her shots every 3 months but I would rather use a more holistic treatment. Anyone have any ideas?

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I do not have any personal experience with EGC, but I remember TCS member @Burkey really made an effort to try different things. Here are a few those threads:

http://www.thecatsite.com/t/272700/royal-canin-canned-rabbit-what-to-do-now-egc-updated-post-6

http://www.thecatsite.com/t/276650/cat-with-allergies-antihistamines-or-desensitization-shots

http://www.thecatsite.com/t/286358/atopica-best-to-give-with-food-on-empty-stomach-or

Perhaps some of the treatments mentioned in these threads can be discussed with your vet.

Vet paraprofessionals often wind up with those odd cases that don't have classic symptoms or don't respond to the usual treatment. I've been there, with a very skinny hyper 15yr old hypothyroid dog (should be fat and tired chronically before diagnosis), and early renal disease kitty with no sign via bloodwork, happenstance finding on a limited abdominal ultrasound for something else entirely. Your dad's cat limited response to the steroid for his EGC is another example, as most cats granulomas respond well to corticosteroids.

Prednisolone at 5mg twice daily is often used initially to get the inflammation down to manageable, then lowest effective dose (twice a week is the typical lowest). Depo Medrol injection is usually effective if only needed once to twice a year for an inflammatory flare up of the eosinophils aggregating at healthy skin and starting an ulcerated area. For the persistent chronic cases, Depo isn't used because more than three times a year dosing puts cats' heart health, kidneys, pancreas and stomach at risk; it's not used at all in cats with heart murmur, any kidney value elevations (azotemia), diabetes, or sensitive GI tract/vomiting history.

Eosinophilic granulomas are limited by keeping him from self-traumatizing lesions by scratching/licking, keeping them dry (No cream/ointment), and feeding him limited ingredient/novel protein food (Hill's z/d or Royal Canin Rabbit/Potato for ex) as dermatologists have already linked diet to the inflammatory response EGC cats experience. Also, supplementing with omega fatty acids i.e. concentrated fish oil at 150mg EPA per day minimum in the suspension/capsule daily, and B-complex vitamins, as well as maintaining a SAFE effective dose of cortocosteroids.

Probiotics, specifically FortiFlora and Proviabe for cats, help limit GI issues, which may start due to generalized inflammation triggered by the EGC. Proviable is the preferred probiotic option, with better bacteria colonies that survive the stomach acid environment to be absorbed in the small intestines. It and Welactin fish oil for cats (has that potent dose of EPA, the most effective antiinflammatory omega 3 fatty acid) are made by Nutramax Laboratories.

Atopica (cyclosporin) has been the preferred treatment for EGC since 2006-07, as it was found by clinical trial and error with various steroids/antibiotic combos to help with chronic skin allergies and cats with EGC when originally prescribed to cancer patients. It can be difficult to convince a cat to swallow, as it's bitter, both the capsule and suspension forms. Your dad could ask his vet to call in a script to a compounding pharmacy, of which VPA and RoadRunner Compounding pharmacies have had the best success evenly distributing the med in suspension and masking the bitterness. Often, a low once daily dose is effective initially, then decrease to 2-3x weekly, with rare side effect on liver health, more so in dogs with atopy that have used for many years. Still, less risk than chronic steroid use.

Hope your dad finds the combination of supplemental therapy, diet therapy, and cyclosporin therapy that magic combo that finally, successfully helps his EGC boy. It's a drawn out battle, as granulomas themselves take weeks to heal once effective treatment is started, before you don't see that raw open skin anymore. Good Luck!