Possible Dry FIP Misdiagnosis?

Hello everyone!  After going through a ton of testing, our 5 year old cat, Roo, was diagnosed with dry FIP this morning and my family is (obviously) very upset and have some questions about dry FIP....first though I'll give ya'll a bit of history on Roo:

• He was found as a small kitten (3 months?) on an airport field.  We did not get him from a cattery or shelter. 
• When we found him he was rough condition.  Thin, weak, and his paw pads had been burned off--we think maybe from being on hot concrete at the airport?
• After two months of TLC his paw pads healed and he acted like a normal kitten.  We had another 6 week old kitten (Tigger) who he played with and they became (and still are) best friends. 
• Both Tigger and Roo are indoor cats.
• When he was 3 years old Roo developed a skin allergy and had a handful of 'allergy shots' to help with the itching---about 4 shots total. Other than that he has been totally healthy. 

​Here is how we ended up with an FIP diagnosis:

• About 8 months ago we noticed Roo wasn't feeling great.  He was still eating, would still play, something just seemed 'off'.  We took him to our local vet who did some blood tests and a radiograph (bloodwork came back normal) and found what he thought were disks rubbing together in Roo's spine and suggested we do laser therapy and Adequan shots...which we did.  At this time Roo was around 16 lbs.
• Two months later Roo had lost weight (he was now 12 lbs).  He was still eating but was very picky and his right eye looked odd.  We took him back to the vet who said he had had uveitis and gave us steroid eye drops.  We did this but the eye did not improve.
• One week later we took him to a different vet about his eye who said she thought he had an eye ulcer and we needed to see an animal ophthalmologist who works at an animal hospital a different city.  In the meantime though, she gave us a prescription of Onsior (for inflammation) and we noticed a drastic improvement in Roo.  His appetite got better, he would walk around the house and try to play.  He looked like his old happy self. 
• We got in to see the ophthalmologist pretty quickly and he diagnosed Roo with severe uveitis in both eyes and an ulcer with a detached retina in the right eye.  He then sent us downstairs to Internal Medicine because he believed the uveitis and detached retina was being caused by something deeper in Roo's body--probably cancer. 
• Now Roo has a ton of tests done.  The Internal Medicine vet drew blood, did an ultrasound, aspirated his spleen, and did an echocardiogram because he heard a small heart murmur. 
• The ultrasound came back showing nothing, the echocardiogram showed a mild thickening of his heart but nothing big enough to treat, and the bloodwork came back showing elevated globulins, high white blood cell count, and a low gut function.  Everything else in the bloodwork (liver, kidney, metabolic, etc...was normal).  He did not have the bloodwork showing whether or not Roo had a fungal infection back yet, but felt pretty sure we were dealing with a fungal infection (toxoplasmosis) and sent Roo home on Clindamycin.  He also took Roo off Onsior.
• One week later Roo's appetite was worse.  He would only take two or three bites of food and then walk away.  He also wasn't moving around a lot.  We called the Internal Medicine vet to let him know and get the rest of Roo's bloodwork results.  He said the results show no fungal infection and that Roo needed an endoscopy.  So we do the endoscopy.
• After the endoscopy all the vet can find is IBD.  Honestly, we are thrilled because we want Roo to be okay.  He sends Roo home on omeprazole, Atopica, and Prescription Diet Z/D.  He also sends us with B-12 shots to give Roo once a week to help with any malabsorption. 
• Three days later Roo starts walking funny.  He is alert but when he gets up to walk he arches is back (like a halloween cat) and wobbles four or five steps before he lowers it.  At this point he can walk but not a straight line.  His appetite is now at zero (he hates the Z/D) and I am syringe feeding him A/D per vet's request. 
• We alert both our local vet and the Internal Medicine vet that Roo is walking funny with vestibular looking signs and they say to watch him over the weekend.   
• Over the weekend Roo's walking get's worse and by Monday he cannot walk on his own.  We know his legs still work because he will reach for my mom with his front paws when he wants to be held and will push against us with his back paws to protest the syringe feeding.  He just cannot stand on his own.  He is still alert though and will even let us know when he needs to pee by reaching a paw in the direction of the litter pan and looking at as.
• We take him back to our local vet (as the Internal Medicine vet is now on vacation for the next two weeks) who is very concerned about these symptoms and draws more blood.  The bloodwork comes back pretty much the same as before....everything is normal except for a high white blood cell count, elevated globulins, and now some mild anemia.  She tells us Roo needs an MRI and sends us back to the animal hospital.
• The first Internal Medicine vet is still on vacation so Roo sees a new vet who tells us it is either FIP or lymphoma of the spine, but that the MRI will show for sure which one.  She also suggests doing a spinal tap which we agree to.
• We did the MRI yesterday (Roo is still at the hospital) and it came back showing inflammation of the spine.  Honestly, things start to become very fuzzy because things don't make a lot of sense.  First she (the new Internal Medicine vet) says she sees two lesions on Roo's spine, but then says she's not really sure. Besides the possible two lesions and inflammation the MRI is normal...so now we are told to wait for the spinal tap results because they will definitely tell us something.
• This morning the spinal tap results come back ruling out lymphoma and showing only a diffuse inflammation.  So....she's is saying this leaves only dry FIP and Roo only has a few days to live.

I know that is A LOT of medical history but I'm not sure I agree with this vet's diagnosis.  We know most of Roo's history and he has never been in a situation to get FIP---unless he got it as a three month old kitten.  I guess my questions are:

1. Has anyone here had a cat with dry FIP?
2. How did the signs manifest and how long before the cat died?
3. Is there anyway this vet could have misdiagnosed Roo and be telling us FIP because she doesn't know what is wrong with him?

We will be picking Roo tomorrow morning...we were supposed to get him today but we asked if they would put in a feeding tube and they didn't do it until this morning....so we can't pick him up until tomorrow morning. 

Thanks for any info ya'll have! 

I forgot to add that, while Roo still isn't able to stand or walk, he is alert.  He knows who we are, knows his name, knows when we wants something (like a litter box or his favorite toy---beads on a string).  He does not have seizures.  Also, his eyes have improved since seeing the ophthalmologist.  The ulcer has healed.  He did lose vision in the right eye (from the retina being detached) but when the ophthalmologist saw him last (about two weeks ago) he said that, besides the retina being detached, his eyes looked better and Roo's corneas looked healthier.  I'm not sure if that would happen if he had FIP?

We just put our 7 month old to sleep last Fri (God, has it been a week?) for wet FIP after a 3 month struggle with dry FIP. FIP is a difficult diagnosis on a good day. It is generally what we call a "diagnosis of exclusion" meaning when you have tested for everything and it's all negative, you are left with FIP. 5 years old is an odd age for FIP but not unheard of. Usually it is less than 2 and over 12. Have they tested his corona virus titers? Can you post his labs? A positive corona virus titer is not of itself a diagnosis for FIP and most cats have been exposed but if it is high, it is more indicative of FIP. What is his A/G ratio: Albumin/globulin ratio? While a

I am so sorry you lost your kitty--we've been reading about FIP all day and it really is a horrible disease.  Yes, the vet basically said that they are diagnosing him by exclusion--since they can't find anything else they're saying it must be FIP.  I don't have Roo's bloodwork with me right now but one of the vets tested for FIP and it came back negative.  I remember being relieved and thinking FIP was off the table.  I even told my mom, "well now we know it's not Feline Leukemia, FIV, or FIP". 

My dad is going by the animal hospital tonight to get all of Roo's labs and test results and I will definitely post them.  So far, the vets at this hospital will not actually let us see his test results...they just tell us that he has high globulins (not sure how high), high white blood cell count (again not sure how high) and mild anemia.  Never said anything about the albumin to globulin ratio.

Also, I haven't been able to find out how quickly FIP kills, but it seems to me that if Roo had FIP he would have died already?  I mean, he's been fighting this for quite a while so it seems to me that, if it were FIP, it would be quite advanced and they would see it in the bloodwork?

Thank you for the link to the FIP Fighters page---I'm going to go check it out now!

RoosMommy said:

 
I am so sorry you lost your kitty--we've been reading about FIP all day and it really is a horrible disease.  Yes, the vet basically said that they are diagnosing him by exclusion--since they can't find anything else they're saying it must be FIP.  I don't have Roo's bloodwork with me right now but one of the vets tested for FIP and it came back negative.  I remember being relieved and thinking FIP was off the table.  I even told my mom, "well now we know it's not Feline Leukemia, FIV, or FIP". 

My dad is going by the animal hospital tonight to get all of Roo's labs and test results and I will definitely post them.  So far, the vets at this hospital will not actually let us see his test results...they just tell us that he has high globulins (not sure how high), high white blood cell count (again not sure how high) and mild anemia.  Never said anything about the albumin to globulin ratio.

Also, I haven't been able to find out how quickly FIP kills, but it seems to me that if Roo had FIP he would have died already?  I mean, he's been fighting this for quite a while so it seems to me that, if it were FIP, it would be quite advanced and they would see it in the bloodwork?

Thank you for the link to the FIP Fighters page---I'm going to go check it out now!

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Len fought for 3 months. Some on steroids can go 6 months or longer. If his corona virus is negative, then it can't be FIP but that is about all that you can test and say no FIP. You vet should give you a copy of ALL tests. This shouldn't even be a discussion.  Again, Len had an almost normal A/G ratio so it's not perfect. But when the A/G ration is low, like 0.4, that is more of an indicator. Has he had a fever? One of the hallmarks of FIP is fever unresponsive to antibiotics. We tried 4 different ones.

CindyCRNA said:

 
You vet should give you a copy of ALL tests. This shouldn't even be a discussion.  Again, Len had an almost normal A/G ratio so it's not perfect. But when the A/G ration is low, like 0.4, that is more of an indicator. Has he had a fever? One of the hallmarks of FIP is fever unresponsive to antibiotics. We tried 4 different ones.

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I completely agree, there is no valid reason for a vet to withhold test results.  Honestly, I've never heard of this before.  We lost a kitty to FIP at barely 3 yrs. old and as CindyCRNA said he also had fever unresponsive to antibiotics.  Sending special thoughts your way for Roo.    Please keep us posted.  

CindyCRNA said:

 
Len fought for 3 months. Some on steroids can go 6 months or longer. If his corona virus is negative, then it can't be FIP but that is about all that you can test and say no FIP. You vet should give you a copy of ALL tests. This shouldn't even be a discussion.  Again, Len had an almost normal A/G ratio so it's not perfect. But when the A/G ration is low, like 0.4, that is more of an indicator. Has he had a fever? One of the hallmarks of FIP is fever unresponsive to antibiotics. We tried 4 different ones.

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Roo has already been fighting this 'mystery' illness about 6 months and has not had any steroid treatment.  The most he has had is some Onsior for a few days, omeprazole, and Atopica. His days on Onsior were his best days though.  My father was just at the animal hospital trying to get copies of the test results but they said they wouldn't have them ready until morning...which is a bit frustrating.

They never said anything about his A/G ratio---only that his globulin was high but, so far, have never shown us or told us any actual numbers. 

Roo does not have a fever and has not had one this whole time. In fact, right now he has a low temperature.  They were supposed to put his feeding tube in yesterday after doing the MRI and spinal tap, but didn't because his temperature dropped.  And, while my father was trying to get the test results, they mentioned that Roo's temperature went low again when they put the feeding tube in this morning. 

And as far an antibiotics---we've had three vets tell us that Roo's body is fighting "something" and not one of them has tried any antibiotics.  So I have no idea whether he would respond to antibiotics or not?  Honestly, I thought the Internal Medicine vets would send him home on antibiotics right away (we started seeing them about three weeks ago) but they haven't.  All they do is test and I'm a little afraid that they're going to "test Roo out of time" if you know what I mean? 

Neely said:

 
I completely agree, there is no valid reason for a vet to withhold test results.  Honestly, I've never heard of this before.  We lost a kitty to FIP at barely 3 yrs. old and as CindyCRNA said he also had fever unresponsive to antibiotics.  Sending special thoughts your way for Roo. 

  Please keep us posted.  

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Thank you!  We will definitely keep you posted. I'm not too thrilled with these specialists and their not giving us the tests results.  Our local vet is pretty good and went over his first set of results with us and, at that time, the only thing that was off was a high white blood cell count and high globulin.  Everything else (including albumin) was okay.  However, I plan to get a copy of those labs tomorrow also.   

If he's got a high white cell count then he's definitely fighting 'something'. Have they done cultures looking to see what it is?

Aerobic & Anaerobic Cultures*(401) and 402 gram stain add on.

Feline Coronavirus (FCoV) RealPCR[emoji]8482[/emoji] Test(1714) or FIP Virus RealPCR[emoji]8482[/emoji] Test (test code 3630) if they strongly suspect FIP.

Here are two tests your vet can order from iddex labs.

He has a high white count and no one has thought to do a trial of antibiotics! I would be running to a new vet! You shouldn't have to be that proactive! Your vet should be suggesting treatment. If it is an infection ( 6 months is long time!) they need to try antibiotics. If it is not, they ned to do steroids but they need to do SOMETHING! 

PLEASE go to FIP Fighters on Facebook. When you get lab results, you can post them over there. There are a lot of experts there that can help.

I know it's kind of late but here is a brief update on Roo....we went to see him around 8:00 this evening (the animal hospital is about an hour away so visiting him takes a while) and when we saw him he looked pretty bad....like he might not make it through the night. So we requested they release him and have brought him home. If Roo's time is up, then we want him to leave in his own home surrounded by his family.

We still weren't able to get the blood work (I'm sending my father back to get it tomorrow) but here is what I know about his condition so far:

He has a low temperature and when his temp drops so does his blood pressure, so we are working to keep him warm.

His spinal tap came back showing "neutrophilic pleocytosis"--I'll be looking this up in the morning.

The vet wrote on his discharge instructions that he was diagnosed with FIP based on "elevated globulins, uveitis, and progressive decline despite treatment for IBD".

Seriously, I can't figure out why he was never given antibiotics! When we first went to this animal hospital I expected them to send Roo home on antibiotics immediately (that seemed like a logical first step) but instead they just waited weeks for test results to come back and now Roo is very sick.

If there was some kind of legal action I could pursue I would because these people have wasted our money and, most importantly, Roo's time. And I feel that the diagnosis FIP is wrong. He just doesn't have the symptoms (I still plan to post his blood work to the FIP Fighters group once I get it though).

Thank you guys so much for your responses though..I will continue to update ya'll and will be posting questions to FIP Fighters tomorrow. Even though he looks bad we still haven't give up on our sweet Roo.

I forgot to add to that they have (finally) started him on some prednisone for the inflammation. So at least Roo is getting some steroid treatment now.

Oh thank God!! You should not have had to fight for that.  Here's praying it's not FIP.

How is Roo doing today? I'm shocked that they had you running around spending what has to be thousands of dollars without even suggesting tests for the most common viruses and bacteria. It's just negligent on their part. You'll see Neutrophilic pleocytosis in bacterial meningitis, and I'm sure in several other diseases that cause systematic infection.

RoosMommy said:

If there was some kind of legal action I could pursue I would because these people have wasted our money and, most importantly, Roo's time. And I feel that the diagnosis FIP is wrong. He just doesn't have the symptoms (I still plan to post his blood work to the FIP Fighters group once I get it though).

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Here you go:  https://www.avma.org/public/YourVet/Pages/Complaints-against-Veterinarians.aspx

MingsMongols said:

How is Roo doing today? I'm shocked that they had you running around spending what has to be thousands of dollars without even suggesting tests for the most common viruses and bacteria. It's just negligent on their part. You'll see Neutrophilic pleocytosis in bacterial meningitis, and I'm sure in several other diseases that cause systematic infection.

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Roo made it through the night!  However, he doesn't look good at all.  He is pretty much paralyzed (cannot stand but is able to move his legs and flip his tail around) and is very weak.  He definitely digressed even more while at the hospital--which is irritating because whenever we called to check on him they told us "yep, he's alert and doing good..." but when we went to visit him they were like, "yeah, he's really gone downhill neurologically".  Had we known he was going downhill we would have picked him up much earlier.   

My father went back again this morning to collect Roo's paperwork, and they gave him everything EXCEPT the bloodwork.  I so badly want to drive back and insist they give me the bloodwork but the hospital is far enough away that I'm going to have to wait and get it Monday.  While he was there though, he asked why Roo was never given antibiotics.  At first the vet on call told him it was because Roo had either a fungal infection or cancer and antibiotics wouldn't help either of those. However, when he said Roo had been diagnosed with possible FIP, but had never been treated with antibiotics to see how he would respond she changed her tune and called one of the "specialists" who had worked on Roo.  So now that he's basically dying, they've decided to try a round of antibiotics---they prescribed Veraflox for him and we're going to see how he responds.  I know it's unlikely the antibiotics will work, but I want to be sure that we tried everything possible to save him. 

I still don't have the bloodwork results but here are Roo's MRI and spinal tap results:

MRI Findings:

Evidence of ependymitis, meningitis, chorioretinitis, and suspect myelitis.  An ill defined expansile lesion of the left kidney with poor corticomedullary distinction.

Spinal tap:

Fluid is of moderately to markedly increased nucleated cellularity and good diagnostic quality. A 100 cell count differential is comprised of 91% nondegenerate neutrophils, 2% monocytes, and 7% small lymphocytes.

Low numbers of red blood cells are present in the background.  No evidence of neoplasia or infectious agents.

Spinal Tap Comments:

No infectious organisms found. Culture with sensitivity may be helpful to rule out occult infection.  Differential diagnoses for neutrophilic pleocytosis include FIP, bacterial or fungal meningitis, protozoal infection, acute trauma, and neoplasia.  No neoplastic cells are observed in this sample. 

One of the papers did have a list of things Roo has been tested for and a FIP/Coronavirus titer was not on the list---so I think made a mistake thinking they had tested him. Here is how the list reads:

Negative for fungal disease

Negative tick titers

Negative toxoplasmosis titer

Negative coccidioidomycosis

Negative cryptococcus.

I've done some reading on the internet and see where things seem to point towards FIP--like the ependymitis, meningitis and myelitis and all the fungal coming back negative. However, I'm not a vet (and I don't trust the vets working on Roo) so I'm wondering if any other FIP cats have had MRI or spinal tap findings that look like Roo's?

Neely said:

 
Here you go:  https://www.avma.org/public/YourVet/Pages/Complaints-against-Veterinarians.aspx

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Thank you...I'm going to check that out right now! If these doctors could have saved Roo or even been a half way honest with us, I would feel differently.  But seriously, I feel like they withheld treatment (even if it was only treatment for symptoms like inflammation and pain) saying that we needed just one more test to know which medication Roo needed, and once they performed (and we paid for) every test in their clinic, they sent him home die.  I know that sounds harsh, I am just really upset at how sick Roo has gotten under their care.   

Thanks for the link!  I am going to go check it out right now.  Honestly, had they helped Roo or even been half way honest I would feel differently.  But I feel like they withheld treatment (even if it was just treatment for inflammation or pain) telling us that we needed just one more test to know for sure which medication Roo needed. And once they performed (and we paid for) every test in their clinic, they sent Roo home to die.  I know that sounds harsh.  I'm just really upset at how badly Roo has declined under their care.