Online Vet Discusses Feline Eosinophilic Granuloma Complex

Ask an Online Vet About Feline Eosinophilic Granuloma Complex

Eosinophilic granuloma complex is a common and underdiagnosed disease in cats.  It is thought to be due to an allergic reaction, and symptoms range from ulcers, swollen nodules, and raised red lesions on the cat’s face, mouth, neck, belly, limbs, or groin area.  Because of it’s allergic origin, there is no cure, but treatment is aimed at preventing the allergen exposure, and therefore limiting the outbreak of clinical signs.

Example Q&A for a pet with suspected Feline Eosinophilic Granuloma Complex

Pet Parent Initial Question:

My cat has a recurring condition that expresses itself on his lower lip and on his neck. His lip gets swollen and blistered and his neck gets bumpy, scabby places. I have brought him in several times — he has received antibiotics twice and steroids once, all of which took care of the problem — temporarily. My vet said that he could possibly have an allergy to plastic or porcelain dishware. He now eats out of stainless steel dishes (although they sit in a plastic container). He eats Nature’s Abundance cat food, which is really high quality and super natural. Of course, his kitty litter box is also plastic. I have a picture of his lip. I don’t want to do antibiotics or steroids again because that obviously only was a temporary fix.

Any ideas? Thanks…

Dr. Jed

I have received your question and have consulted with another vet. I have some questions…

1. How long has this been going on?

2. Since you have a photo, can you upload it when you respond using the “Add Attachement” “Choose File” option below the typing box?

3. Is it wet/oozing or is it dry? Does he scratch around the collar? Usually we see one or the other–lip problems or neck problems. Any small black bumps (very small) around either areas? Chin?

4. Do you have other pets?

I’ll need this information to help you. I have a few ideas of what it could be , but because it is both the neck and the lip, I definitely need this info back along with a picture. I also want to talk to other vets to see if they have seen this and forward them the pic.

Look forward to your answers and a picture and helping you out.

Thanks,

Dr. Jed

Pet Parent:

Hi Dr. Jed,

1. He will be two years old on April 15th. I have had him since July of 2009. So, in a year and a half I have had to take him in three times for this same thing. He came from the pound, but I am certain he is partially Siamese, because of how he looks and because he talks a lot.

2. See photo

Feline Eosinophilic Granuloma Complex Upload

3. His neck ailment is dry. It doesn’t bother him and he doesn’t scratch it. I can feel it and when the vet has shaved his neck you can see it as scabby and bumpy — the bumps are definitely subcutaneous, though, and only some of them scab. Not oozy. No other bumps anywhere else.

4. I have no other pets. But he does have a habit of licking soap and chewing on plastic bags and bubble wrap (I try to keep them out of his reach). He is an indoor cat.

I did buy a wooden and stainless steel feeder at the pet expo this weekend in the hopes that it might help…

THANK YOU.

XXXXX!

Dr. Jed:

The picture speaks a thousand words! We are writing you an answer. It takes several minutes because we write these from scratch. Although we can’t give you a definitive answer/diagnosis we can point you into what disease we highly suspect it is.  Here is a photo of another cat with this lesion definitively diagnosed.  Notice the resemblance:

Eosinophilic Granuloma Complex Upload

Dr. Jed:

This really looks like Eosinophilic Granuloma Complex in Felines. There are a bunch of names for this such as “button ulcers”, “rodent ulcers” and EGC… I have attached a picture of a cat close-up of another cat diagnosed with this problem. I have been treating these for quite some time with great success.

Eosinophilic granuloma complex can either be linear or round. The lesions are typicall red/pink, hairless, and can be raw and ulcerated. Most of the time they are not itchy. The most common lesion is a swelling of the chin area, just like Ike has. It is commonly reffered to as a pouty chin. Lesions can also be found on the backs of the legs, foot bads, belly, and neck. Armpits can be affected less commonly. Lesions on the neck, belly, back, neck, and thighs are more likely to be itchy than ones around the mouth.

When they get really bad, they can develop something called an indolent ulcer. Indolent eosinophilic ulcers occur as a raw depression or even erosion in the skin of the lips. They can be on the upper lip, roof of the mouth, or back of throat. These are usually always painful and itchy. Even nearby lymph nodes can be enlarged.

The basic appearance of these (and Ike’s) lesion is very suggestive of eosinophilic granuloma complex in cats. Testing can confirm the diagnosis, and the good thing is that the diagnosis is easy and affordable! Eosinophils can be found when smears of the lesions ae examined under the microscope. If your vet isn’t familiar with diagnosing this, you can request the slide be sent out for review from a board-certified cytologist. This will usually cost you around $70-100 and take a few days for an answer. A skin biopsy is the most definite way to diagnose it with the biopsy sent out. This does require heavy sedation.

Treatment: Unfortunately, there’s no quick fix. Treatment involves several different steps. Eliminating underlying allergies is key.

Goals:

#1: flea control: treat Ike with frontline or Advantage to rule that out as a cause and to prevent immune stimulation (if he’s super sensitive, just a single flea can set his system into a downward spiral)

#2: Consider a hypoallergenic diet such as a hydrolyzed prescription diet or a new protein they haven’t had. VetLIVE is not associated with any food company or any other company at all, but I have had great success with Royal Canin’s hydrolyzed diets just because the cats will actually eat them

#3 You can go down the road of doing allergy testing, but don’t do that until the other causes are ruled out.

Now, antibiotics may be necessary and admistered when the lesions get infected. Steroids can be used to shrink the lesions. I think your vet has some good ideas and may have been thinking along the same line here.

The underlying cause of this condition is believed to be a form of an allergic reaction; that is, the immune system overreacts to something to which the cat is exposed. Possible inciting agents include the following:

  • Environmental allergens
  • Foods
  • External skin parasites, such as fleas, mites, or lice
  • Bacterial skin infections
  • Fungal infections of the skin, such as ringworm
  • Viral infections, such as feline leukemia virus or feline immunodeficiency virus ( make sure he tests negative for these)

I have had great success with treating with injectable corticosteroids. I usually start with Triamcinolone acetate (vetalog) injections to see if they are effective before moving on to methylprednisone (depomedrol). Risks can include diabetes mellitus, cushings disease, and delayed tissue healing with both but more so the later so that is why I start with the less potent steroid.

Oral antibiotics such as clavamox and antihistamines such as chlorpheneriamine maleate can also help, and can be used in combination with holistic approaches such as essential fatty acids by mouth.

Prognosis:

With adequate control of the underlying allergy, the prognosis is good; however some allergies are difficul tot identify and control. If the lesions are food or flea, preventing this is much easier. If it is an environmental allergy, it can be harder to control, and therefore reoccurences are more likely to happen.

In the long term treatment, if the steroids have a problem, cyclosporine can be used which does have side effects but is not a steroid. There are other drugs that can be used, and often these guys can grow out of it or just need “pulse therapy” when they start to get another granuloma.

Sidenote:

Feline eosinophilic granuloma complex is not a specific diagnosis. A primary underlying cause is likely to be present and should be investigated and treated (like ruling out the bowl in Ike’s case). Although we cannot diagnose over the internet, this is highly suspicious of this disorder. Please be sure to have a look at the picture of another cat with this disorder. It’s text book appearance (actually the pic is from a textbook)!

You sound like a great pet owner. I hope this helped and I really hope you can use this information along with working closely with your vet to not only find out if it is indeed what we think it is but also to make Ike better, and find the underlying cause.

Best of luck to you and Ike,

Dr. Jed

Pet Parent:

Thanks for the thoughtful, detailed response….

XXXXX!