mysterious vision loss

Poor Pawnee... you may remember she survived a terrible vaccine reaction a year ago.  Well, over the summer, she has just not seemed right.  Quieter, a bit clumsy (occasionally missing a jump onto a chair, for example), more finicky about her eating, etc.  After several years of downing all her S/O canned food at every meal (she has a history of cystitis), she simply refused to eat it any more, and we're cycling through endless types of food to keep her eating.  She seems to be at the water dish more frequently.  Finally, I took her to the vet in early October.  Full physical exam, basic blood panel... all normal.  Vet cannot find anything out of the ordinary.  Then two weeks ago, she happened to look up at me and I saw one eye looked cloudy.  On closer inspection, the back of the eye was white, chalky-looking... not at all the usual shiny black or reflective state.  Took her back to the vet, who not only agreed the eye looked wrong, but heard a loud heart murmur that *had not been there 6 weeks before.*  Hundreds of dollars in lab work and xrays later: ALL normal except her toxoplasmosis titer was *slightly* elevated.  A week of clindamycin has had no effect.  She has NO fever,  her blood pressure is fine, her kidney values are fine.  Her lungs on xray look a little bit fuzzy, my vet said almost like an asthma reaction - but her lungs sound clear, she has no coughing or labored breathing and her respiratory rate is in the high 20s.  No tumors apparent.  So... we are starting to think maybe a fungal infection??  She is going to the ophthalmologist tomorrow, in the hopes that we can at least figure out what is going on with the eyes.  Her vision is definitely impaired, and both eyes rather more dilated than normal.  BUT it's worst in the morning: she can't find her food dish unless I help (she stepped right in it this morning)... but in dim light she seems much better.  Last night she went outside (we escort her and watch her) to pee under the deck, which she did, then hopped right through the railings to come back up without hesitation.  If the ophtho thinks it looks like a fungal chorioretinitis, we will test her for histoplasmosis and/or Valley fever, and treat accordingly.  She is originally a Kansas barn cat (she adopted us there), and for the last few years we had been letting her go outside when we go to our second home in central KS, so it's possible she was exposed that way.  She's under permanent house arrest now, except for brief supervised forays outside.  We can do blind (my late, much-mourned Italian Greyhound William was blind for the last 7 years of his life), but we are more worried about whatever caused it systemically and how that might play out.  Anyone been here??  We are mystified and concerned.  Don't tell the others, but she IS our favorite cat, and I firmly believe the Best Cat Ever in the History of the Universe.... :-(   (Photo below taken when her eyes still worked...)

Julie and Pawnee

Hi jstie, What a sweetie! I can see why you are worried, especially with such a much loved cat. I can't help with the issue, I have no experience with it, but it seems to me a lot of nasty things were ruled out, that's good! How old is she? Let us know what the ophtho says, but from what I read here the vet should be able to determine whether she has this infection or not. Let us know!

http://www.petmd.com/cat/conditions/infectious-parasitic/c_ct_cryptococcosis

Our best guess is that she is 8 or 9.  She was tested for cryptococcus and it was negative. 

That's good news! If the fungal chorioretinitis is ruled out, then hopefully is will be something easy to treat.

And the answer is: histoplasmosis.  Both serum and urine titers came back positive today.  I am going out to pick up the fluconazole in a few minutes.  The good news is: the antifungal best for treating nervous system / eye involvement is the one that costs one fifth as much as the other one.  There is a local pharmacy who is compounding it for us.  She is generally in much better shape than many cats with this, so we are hopeful she will respond and get better.  The ophtho said both her retinas were affected and partially detached, but that she is NOT blind in either eye, but rather just has blurred vision.  A combination of low-dose steroid and the antifungal might even allow them to reattach and her vision could improve.  So... think good thoughts about a pussycat, and I will be trolling the other histo threads here and hope I don't get too scared...

Julie and Pawnee

More on Pawnee... we got the compounded fluconazole on Wednesday night.  Brought it home, syringed it into her mouth, and Phhhhbbbbbtttttt!  She foamed, she drooled, she spat and spewed it everywhere.  Back to the pharmacy the next day, who kindly made up a new batch at no charge that smells and tastes like the rankest cheap grocery store tuna cat food.  She started to spit, then stopped and went, "Oh. Wait. Tuna!" and swallowed it down.  So we've been on it twice a day for four days, plus 2.5 mg prednisolone once a day.  She is eating better than she has in a long time, cleaning her plate at every meal.  She is still very quiet, mostly resting or sleeping, but she toddles out into the kitchen at mealtimes and chirps and meows at me for her meal, which I think is a good sign.  This morning at 4:30 am she popped up onto my pillows, purring and licking my nose, which she also has not done in a while, so I hope something is making her feel better.  Her weight and coat look good, she is grooming herself nicely.  She has never had the respiratory issues I've read about - her breathing is steady and normal, vet said her lungs sound clear.  My vet went out and bought a new lens for eye exams for her, and said her retinas look better to her than they did ten days ago.  So... we are in wait and see mode.  She does not seem as dreadfully ill as other cats I have read about, but we do suspect her immune system is wonky based on her vaccine reaction on 2014.  So... wait and hope... Sigh.  We do love her so.

Julie & Pawnee


Pawnee and her frenemy, the Werewolf (an acute pancreatitis survivor this summer... it's been a tough year)