Do Granulomas (Rodent Ulcer) Come back?

OK  I know I have a few threads going  but I thought I would see if I could get some feedback about Eosinophilic granuloma. My kitten Simon developed what looked like a fat lip sometime in December. I have know idea what triggered it but it required a trip to the vet. The first time I had him looked at, the vet sent him home hoping it was just a injury from kitten play with his mate. Well obviously it was not healing so I brought him back in a few days later. The vet prescribed him Prednisolone 5mg everyday till the lip went back to normal then one tablet every other day till finished.

He responed quickly to the treatment, and in around a week he looked normal again. He is still on the pred and will be dome the treatment in 3rd week in March. That just seemed like a long treatment to me, but I am following the vets instructions.

I am wondering if this condition will return after treatment or not? If it does continue to show up, is there a way to control it without using steroid drugs? Any advice would be helpful.

Yes Rodent Ulcers usually recur.  They are thought to be caused by an allergy in some cats, so a lot are on limited ingredient diets.  My dad has a cat that even high dose steroids daily don't take care of his.  His is the worst case he's seen in 40 years of being a vet.  He has him on Lysine which has helped a little and is adding microlactin to the daily mix.  Every cat is different, it depends on what is causing it.

Maybe Toffee was quite an anomaly, but he had one, and with no ongoing treatment, it never returned again. Maybe we were just lucky??

My Sophie's came back several times, but they just last a few days with no treatment.  Her vet said unless they got really bad she didn't have to go back every time one appeared

*Touches wood* She hasn't had one for over a year now

It's pretty rare, but yes some cats will only have one single incidence of EGC. It almost always returns at some point (weeks, months, years), unless the cause of the EGC has been eliminated. Fleas are the #1 cause, and I think that many of the cats who only have it one time, are on good flea control but one lone little flea snuck through and bit them. When fleas are the culprit, all it takes is one bite, not an infestation of them.

Keep your cat on strict monthly flea preventative, year round. (like Advantage II, for example).

If you maintain good flea prevention, and it does return, odds are you are looking at a food or environmental allergy. Some cats end up being allergic to more than one thing, and it can be tricky to pinpoint.  It could be an immune disorder where the cat's body is reacting to it's own skin, but that scenario is much less common than an allergy to something.

One of my cats has a different form of EGC than yours (there are 3 types), and so far we've ruled out fleas. So now we're focusing on determining whether or not it's a food allergy.

Best of luck, hopefully it will not return and this will be behind you!!

I can only hope that my little guy will be one of the lucky ones that only have this one episode. I have read that it is common for kittens to get it, but it happens on all ages.  It just seemed strange when this thing came out of nowhere.  I agree that finding what caused it would likely be hard. I guess I will have to wait and see how things go after the prednisolone treatment is done in the next few weeks.

Why!!!!! It's only been 11 days since Simon has been off his prednisolone and tonight I was watching him groom and during this he started chewing on his back legs. Sure enough I had a look to see what he was chewing at, and sure enough he had tiny little scabs on both his back legs. Granuloma starting again! I took him back to the vet and she confirmed the findings seem to be the start of another round of granuloma. Yet another round of pills for my little man.

She said that we could try a hypoalegenic diet but I hate to feed vet food. I am starting to think he would be a great candidate for a raw food trial. Who knows, maybe that might just be what he needs. Hoe frustrating this is! I am so bummed, but at the same time I was warned that this could come back. Funny thing is, the first one he had was on his lip, now it is moved onto his legs. Poor Simon.

Poor Simon, indeed!  Instead of a prescription hypoallergenic food, couldn't  you maybe just try a limited ingredient food?  Or, of course, raw, if you're up to that.  I know there are a couple of people who are doing some food trials right now.  Think they are using the Royal Canin Vet food.  OMG, your cat's even look similar!  Here's there thread:  http://www.thecatsite.com/t/272700/royal-canin-canned-rabbit-what-to-do-now-egc-updated-post-6

mrsgreenjeens said:

 
Poor Simon, indeed!  Instead of a prescription hypoallergenic food, couldn't  you maybe just try a limited ingredient food?  Or, of course, raw, if you're up to that.  I know there are a couple of people who are doing some food trials right now.  Think they are using the Royal Canin Vet food.  OMG, your cat's even look similar!  Here's there thread:  http://www.thecatsite.com/t/272700/royal-canin-canned-rabbit-what-to-do-now-egc-updated-post-6

Click to expand...

That would be me.

2crazykittens, I responded previously in this thread, and again in your more recent post on the raw forum. Sounds like you and I are dealing with similar issues (unfortunately!).

One of my cats, George, is 9 months old and he suffers from Eosinophilic Granuloma Complex (EGC).  He was first diagnosed at 6 months old while he was still in rescue (I adopted him at 7 months old). His presents as plaques primarily on his neck and chest, but also to a lesser extent on his thighs, sides, and belly. They start out as little scab like bumps similar to what you'd see with miliary dermatitis, but progress into full blown plaques that are extremely itchy.. The plaques are much bigger than those little initial bumps, sort of like hives or larger flat bumps, and he's just at the point now where he's scratched a couple of them raw. Not fun.

While sometimes it is not possible, the key to controlling EGC is identifying your cat's allergen(s). The most common culprit is fleas. Even one single bite will do it, your cat need not be infested with them. So, if your Simon is on monthly flea control and you've ruled fleas out, food is definitely the next logical place to start investigating!

This is where we are with George.....fleas were ruled out quickly, and now we're in the midst of doing a food trial.  He has been exclusively on Royal Canin Select Protein PR (pea & rabbit) for almost 6 weeks now.  Unfortunately, this particular food has not resolved his EGC symptoms at all, so far. The vet wants us to try to get to the 8 week mark (12 weeks would be ideal), but it is looking like that's not going to be possible.... he's starting to get uncomfortable, and we're going to have to get him on medication to calm his skin down if it continues to escalate any further. Given that his skin issues are progressing, I feel that George is either allergic to peas (they were in his regular food, too), or something in his environment.

Like you, I'm not thrilled with veterinary foods, and almost didn't go this route.  And in retrospect, I wish I had listened to my instinct and gone with a different food for George's trial. The issue is not that his skin is still reacting. That could be due to the peas or him being allergic to something else completely.... I knew going into it that the food trial might not work. The biggest problem with this particular food, is that George has not been able to maintain a good weight. Royal Canin PR might be fine for adult cats, but it is definitely not nutritionally dense enough for a growing kitten. We offer George as much food as he wants to eat, and he just does not eat enough in one day....his tummy is full before he's ingested enough to support his rapidly growing self! In the last 6 weeks, he has gained only 4 ounces, where he should have put on closer to a pound. His vet feels that he's a good 1/2 to 1 pound underweight....and says to feed him more. Uh...we're trying!   On a good day, George will eat 3/4 cup kibble and 1/4 cup canned. That is about 290 calories...plenty for an adult cat. But prior to this food trial, he was eating an average of 330-350 calories per day...and should still be eating that much.

Provided you've ruled out fleas, I do think a food trial is where you should be headed next with Simon. I believe he is roughly George's age? A month or two older, perhaps? If Simon is still growing, be sure to not only be looking for novel & minimal ingredients, but also for a food that he'll eat enough of to support his nutritional needs. You can certainly go with raw if you'd like to. With that route, choose a novel protein (something he's not had before), and skip the carbohydrates completely if you can... they don't need grains, veggies, fruit...and without those you don't have to worry that the CARBS might be the allergen.

I need to get George off the peas while still using a hypo-allergenic diet, and also something that will put weight on him at the correct rate. I hope to have a decision figured out within the next week....our vet's not on board with a food switch yet, but at this point I don't care!  I'm currently considering Hound & Gatos, Addcition (iffy...more veg/fruit than I like for this situation), and raw. I also discovered Ziwipeak and that's a top contender as well. The problem with George is that even though we've made progress towards wet, he still loves his kibble....and all kibble seems to have peas &/or other likely allergens (like chicken, fish). Hopefully he'll go nuts for one of these other canned foods or raw, and that worry will be a thing of the past...but not holding my breath. LOL

Best of luck to you and Simon! If I can be of any help while you're trying to determine the cause of Simon's issues just let me know. Or maybe we can just commiserate together about the stress of the process... identifying specific allergens can be tough, but keeping your eyes on the prize (a healthy cat) makes it all worthwhile.

Thank you so much @Burkey for your fantastic reply. It is so hard dealing with this. Just when you think it is under control, it comes back. Simon is about 9 months and he started to have this issue in December. So he sounds just like your kitties twin. My vet did check for fleas. He was clear. So it must be something else triggering this for him. It could be diet or enviroment but that is going to be tough to determine. My vet also mentioned a food trial, I know they will want to try to sell me on their prescription diet. I refuse to do their foods because it has all the same stuff in it as a bag of friskies pretty much. I can't even risk trying that out since it will not likely help him as you are finding out with your kitten.

I do like the idea of going with a more natural diet for Simon and his brother. It certainly couldn't hurt even if that does not resolve his issue, he will still be better off on a better diet. Raw foods might not be a cure all for everyone, but it might be what he needs if it is in fact a food related issue. He sounds just like me. I suffer from eczema, so I can get a flare up from foods and enviroment. It is so hard to narrow down what causes the flare ups, so in the end I just learn to tolerate it.

I really do hope that I can somehow help Simon out. So far the only relief he gets is with the prednisolone. The vet said that once it is under control again maybe we could get Simon on a 2x a week preventitive dosage just to keep it at bay. I hope that will work but only time will tell.

Is your kitty not on any medication as of yet?

While George was still in rescue, the vet pulled out the big guns right out of the gate.... he had two injections of Depomedrol, spaced two weeks apart, and our vet followed up with a third Depomedrol injection after we adopted him.....three injections of Depo, usually spaced 2 weeks apart is the standard protocol when opting to use it for EGC.  It is not wise to give him any more Depomedrol at this point in time. If any steroid is going to cause diabetes or other maladies, Depo is at the top of that list.  It needs to be used judiciously, and sparingly.

During a food trial, ideally you don't give any medication. You need to be able to watch the symptoms very closely... and if a steroid or similar is keeping things at bay, you have no idea if the food trial is benefiting the cat. So at the moment, George is not being medicated. His skin started to slowly act up again at the end of February, but it wasn't bothering him all that much for the first several weeks. But in the last 7 days or so, it's started to get angry and his grooming and scratching has escalated exponentially.  We are likely looking at medication again in the very near future (I'm guessing oral pred), to calm his skin down again. And once the skin is calm again and the steroid has left his body, we'll press on...

Given that George is so young, I am hoping to do everything humanly possible to discover the cause of his EGC. Submitting him to a life of regular steroid use is not a path I want to go down, if I can manage to avoid it. In general, the side effects of steroid usage aren't as detrimental to cats as other animals. But over time they do definitely take their toll on a cats body, and given that George isn't even a year old yet he has A LOT of life left ahead of him....which would equal a lot of steroids, if we can't figure this thing out.

I should add to the discussion, that I feel the same way as you do about cat food!

When we adopted George, we also adopted Dory, who is 8 months old now. Dory happily eats an entirely wet diet, but our George came to us as a kibble addict. Our initial plan was to get them happily eating better quality food than they were getting in rescue, and transition George to wet....with the hopes that just having better foods would resolve George's EGC. We were using Wellness grain-free and NVI for the canned (with the occasional Tiki & Weruva thrown in), and Wellness Core for George's kibble. We'd gotten him to almost 50/50 wet/dry, when it became apparent we needed to do a food trial because the EGC had not resolved. That shot our plans out of the water, as George is not thrilled with the Royal Canin canned food....we're lucky to get 1/4 can in him most of the time.

It took my husband and I almost two weeks to come to terms with using the Royal Canin, before we gave in and started it. And, we should have gone another route. I feel like the last 6 weeks have been wasted, simply due to the fact that George is now underweight...nevermind that the EGC is still present. We've now got two issues, instead of one.  This weekend, we're going on a "tour" of sorts of all the local pet stores (both chain & independent) to see what we can get locally. I'm not opposed to ordering online, and probably will to save a bit of $, but I like to have an idea of what I can get locally in case we are running low while waiting for the next order to arrive.

I'll let you know what we ultimately end up doing. We'll definitely be making a change in the next week or so....the Royal Canin has to go. If we'd managed to get George to 100% wet before his skin flared up again, this would have been soooooo much easier. I have my fingers crossed that we'll find something appropriate, that is wet or raw, that he'll absolutely devour. But knowing George, I think that's going to be unlikely. If we have to use a kibble, I feel like hope is lost in terms of solving the EGC any time soon.

Rodent Ulcers can definitely come back as cprcheetah mentioned earlier. My big male tabby Max has gotten the indolent ulcers in the past and we believe this was caused by bacteria buildup or something external in the environment. Max has never had anything like this on his legs or torso. As it sounds like Simon had the same initially, I wonder if what you found on Simon's legs, might be something else?

The key to managing RO is to know what the triggers are so that you can prevent flareups before they happen. If you are still using any plastic dishes for food or water, I would suggest you stop using this today and replace with ceramic, glass or stainless steel bowls to prevent future episodes involving the lips. That said, it is also very important to ensure that you wash food and water bowls EVERY day or even after each meal, and this includes any bowls containing dry kibble.

It is also important to think about what you are using in your home for cleaning products, for instance what you wash your floors and dishes with. These products should be mild and contain natural ingredients. I used to use pine-sol and bleach on the floors, but now use vinegar and mild dish soap. You shouldn't need anything stronger. If you suffer from eczema, chances are you are already aware of the importance of this and are using natural products.

I would think twice about introducing regular flea treatments simply on speculation that this might be the cause. Flea treatments are a form of pesticide and you don't want to be giving your cat something that is toxic, if you don't have to. Alternatively, there are naturally formulated flea products that do not contain the toxic ingredients that conventional flea treatments do, if this is necessary.

I wish you (and Simon) the best of luck with this! ...

Rodent Ulcers, are one form Eosinophilic Granuloma Complex (EGC).  EGC is a blanket term for a disease that presents in numerous ways...rodent ulcers, plaques, linear granulomas, intestinal or ocular inflammations caused by eosinophils, and some vets are even now looking at miliary dermatitis as also being a form of EGC.

Compare it to a group of people who all had beef for dinner. One might have had steak, one had pot roast, another had sloppy joes. But they all had beef.  It's the same thing in this case with with rodent ulcers, plaques, granulomas, etc...they're all EGC.

Some cats with EGC will always present with a single form of the disease throughout their lives. But it is also pretty common for a cat to experience more than one form of the disease over time. And to go further, some cats will present with multiple forms of the disease during the same episode.  George originally presented with linear granulomas on his thighs and plaques at his neck, at the same time. This time around there are no linear granulomas, only angry plaques primarily at the neck with a scattered few elsewhere on his body. No one would be surprised in the least to see a rodent ulcer pop up on him sometime in the future...it's all the same disease process....EGC.

The most detailed website I've come across so far, describing EGC and it's many forms, is http://www.2ndchance.info/egc.htm

I agree 100% with the idea of not using flea preventative, when not needed...it's a toxic chemical. I'm a major advocate of less is more, in almost all aspects of my (and my pets) life. But most reports state that 50% or more of EGC cases are caused by flea allergy. And one bite is all it takes to set these cats on fire. So while one is actively working towards identifying an EGC cat's allergen(s), flea control is a necessary evil if you don't want that one random flea that comes along to ruin weeks or months of efforts with one little bite. Figuring out allergies in cats is not easy to begin with. And in cases where severe consequences occur due to the allergy (such as waking up in the morning to a cat that has scratched himself bloody overnight, as happens with George), I'll use the flea control.  If I weren't actively trying to determine the cause of his EGC, I would definitely not be using flea preventative products of any kind.

Yes, I know there are different forms of EGC, but the OPs original question was around rodent ulcers. Her cat's initial experience was with the indolent type of EGC, also known as rodent ulcer.

I get that pets need to be protected from potential allergens such as fleas but I don't agree with the use of commercial flea products that contain toxic chemicals. Unless you know that your pet has an allergy to fleas, or your area is particularly bad for fleas, using flea products for this purpose is like using antibiotics on the chance that you might develop an infection? We don't do this as people or with our pets as we know that antibiotics kill good bacteria, with the bad.

There are natural flea products that are much safer and healthier, if you need to use a flea treatment. Ultimately you need to do what you think is best, and that is what matters. I would just recommend that if you are doing regular flea treatments, to find something that is natural. I had a link to one such product, but don't seem to have it bookmarked anymore. If cprcheetah happens to see this, she might post a source.

Thanks for your replies.

I don't have him on any flea treatment as of now because his fur is clean. I check all the pets and they do not have any fleas at all. All my pets eat only from stainless steel or ceramic bowls I have never actually used plastic because it is gross. I don't feed kibble, only the odd temptation but all my pets eat a wet diet. I really have no idea what brought on this issue in the first place. It came out of no where. I have a mostly carpeted apartment, and I usually use a dish soap too to do some cleaning. Since I brought the two kittens home, nothing ever changed in what I use in the house or the laundry soaps.

I can only hope that what was on Simon's legs was not ECG but it happens to be in a pretty common place. He was really chewing at it too and it seems itchy. I continue to monitor it though.

I am always into trying natural stuff for myself and my pets. If you do come across that link I would love to check it out.

I did try them both out on a little raw tonight. Simon seemed hesitant but ate some with his sardine snack and Mumsy ate his in a hurry. I really hope that I can try to narrow it down for Simon, only time will tell.

2crazykittens said:

 
Thanks for your replies.

I don't have him on any flea treatment as of now because his fur is clean. I check all the pets and they do not have any fleas at all. All my pets eat only from stainless steel or ceramic bowls I have never actually used plastic because it is gross.

I don't feed kibble, only the odd temptation but all my pets eat a wet diet. I really have no idea what brought on this issue in the first place.

It came out of no where. I have a mostly carpeted apartment, and I usually use a dish soap too to do some cleaning. Since I brought the two kittens home, nothing ever changed in what I use in the house or the laundry soaps.

I can only hope that what was on Simon's legs was not ECG but it happens to be in a pretty common place. He was really chewing at it too and it seems itchy. I continue to monitor it though.

I am always into trying natural stuff for myself and my pets. If you do come across that link I would love to check it out.

I did try them both out on a little raw tonight. Simon seemed hesitant but ate some with his sardine snack and Mumsy ate his in a hurry.

I really hope that I can try to narrow it down for Simon, only time will tell.

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Hmm .. Its my understanding that some ulcers are not always itchy, so the chewing you mention makes think of food allergies. You mentioned having eczema, I had this as well when I was quite young but it has gone away through the years. My allergic trigger were certain wools. My brother also developed eczema from early on but had it much worse. He was tested and found to have a serious allergy to peas. Anyway, it sounds like you are doing all the right things and your environment hasn't changed, and so food may be the culprit here. Sometimes it is the meat protein, but it can also be other things like additives, certain carbs, some oils used, or fillers.

I will do a little digging and see if I can locate some sources of the natural flea treatments.

@2crazykittens: Here is a link to an audio discussion by Dr. Karen Becker, DVM where she talks about one natural flea product called 'Natural Flea & Tick Control' : http://products.mercola.com/healthypets/natural-flea-and-tick-control/. Lots of good information here including an overview of spot-on conventional flea products and the problems encountered with this, as well as an explanation of how animals attract fleas and ticks and how this product works to protect your pet from them.

Thank you @oneandahalfcats I saved that to my favorites. Honestly I would rather use something natural at this point since I think all the chemicals are not good for pets. I have know idea what is causing this issue with Simon, but in November or December last year I used some carpet deodorizer and then shortly after that the lip granuloma showed up. It could have been how it started but I really don't know. I still need to shampoo the carpets, but have put it off because of the cold weather. Now that it is spring, I can do it so it is on the list of thing to get done very soon.

I found a cleaning line called Eco-Max that is all earth friendly and hypoallergenic to try out. I will be making the switch to this line just in case simon is allergic to something I am using to clean and launder with. We are still working on the diet change, the raw is going well but it is taking time for him to adjust to it. I changed his litter to Swheet Scoop from the clay, but I don't know yet if that will cause a trigger for Simon since nobody knows what it is that bothers him yet.

I have decided that we will make the switch from the Friskies wet to the Fancy Feast Classic line since the FF has a nice selection and is also grain free and gluten free. It's worth a try since it is readily available and something I can afford along with the Raw. that I can narrow this thing down and my little guy can live a more comfortable life.

I think you will figure this out eventually. You are already moving in the right direction in changing Simon's diet for the better and are committed to doing things as naturally as possible. This will make a huge difference.

If I can make one other suggestion that will help you in this process, it would be to start a journal to track details such as diet changes, supplements introduced, medications prescribed and cleaning products used over time and any associated changes, symptoms, reactions and positive results that you are seeing in Simon as the result. No detail is too small here. This information can provide important clues to make the connection between what is working and what might be triggering reactions based on symptoms he might be having at a given time.

I see that you are a fellow canadian in Ontario. Have you tried any of the PC canned wet food? PC has a pretty decent line called PC Extra Meaty Cat Food which would be comparable to the FF. The PC has meat as a first ingredient and I believe the Turkey & Giblet is one variety that does not contain any glutens. This might be something you could add to Simon's rotation: http://www.presidentschoice.ca/en_C...eaty-cat-food---turkey---giblets-dinner-.html

Here is a link to all of the PC varieties for comparison : http://www.presidentschoice.ca/cont....tag@lclonline!Brand,[email protected]

Best of luck in the days ahead. I would be interested in hearing how Simon does with the Swheet Scoop Litter in particular! ..