Comments

1. 

   Krista Magnifico

   Hello!
   Thank you for helping this kitty.
   I am happy to help, but a few things are important to remember; I do not know all of the local diseases to your area. We live in very different places and animals get exposed to different diseases in different places.
   Based on the history and response to treatment so far I think the antibiotic was warranted and may need to be provided every so often to manage secondary infections due to severity of the cats condition.
   I also think that there is a chance this could be one of the following:
   Infection (fungal or bacterial)
   Immune mediated (pemphigus/lupus)
   Or cancer (squamous cell, etc)

   To diagnose these you may need biopsy or cytology. I would try to resist treating without some ability to rule something out. (Steroids and fungal infections can make things worse).

   Please keep us posted. Very best of luck.
   Krista.

   1. 

      Colin Post author

      Dear Dr. Krista,

      Thank you for your quick response 🙂

      Yes, I’m aware of the dangers of cortisone therapy, but living in the mountains, I’m limited to kitchen table surgery 🙂

      I do also liaise with a kind local lady-vet, who supplies me with whatever medicines I need.

      She too is stumped, and I’ve been here three decades plus +and never seen anything like it before.+

      I tried mixing miconazole in with the various creams I concocted, like you concerned it could be a fungal disease. But I find flours of sulphur cures both mange and ringworm here, if applied gently and persistently enough.

      Yes, the spectre of Squamous cell carcinoma looms, but she is remarkably bright and active.

      Almost no sneezing or nasal discharge.

      The “Rodent ulcers” that I’ve seen look different, and usually just the lips, and the ulcer has a thickened rolled edge: This one is different.

      +Doc., have YOU seen anything like this before?+

      I should mention, she had a lick granuloma on her hip, but that has healed now, with flea-bathing, and the steroids she’s been on. (I don’t like using fipronil, ie. “Poison your pet to poison its parasites”. Not a sound strategy.)

      Can you ask around for me please if any of your colleagues have seen a nose like that, despite over a month intensive blunderbuss therapy? Feel free to post the images on a specialised dermatology group if you know of one.

      Colin

   2. 

      Colin Post author

      Dear Dr. Krista,

      Thank you for your comments. Your mention of locality sparked a line of new thoughts.

      Most of my vet jobs have been in the tropics (Jamaica, Arabia, Singapore etc) where venomous creatures are commonplace (Toads, insects, scorpions, spiders, centipedes, and snakes).

      I’ve seen Arabian horses lamed by a centipede bite, a rare Arabian Oryx die from a snake bite.

      One characteristic symptom I’ve noticed in cats of spider bites is intense, frantic licking of the cat’s body. It is continuous until the toxin effect subsides after a few hours, so mild sedation is called for. It’s clinically distinct from the CNS effects of agricultural toxins.

      This cat has lived around a 24 hour 7/11 shop, and the bright lights at night attract swarms of termites and beetles: Cats love eating termites, +but so do; scorpions, snakes, spiders, centipedes, and toads+ that live in drains.

      Just this week, my other strays brought two live snakes as “love gifts”, one was a harmless Tree-snake, the other a 60cm Red-necked Keelback (small, but whose venom is nonetheless as deadly as the Banded-Krait’s!) (See attached snap I took of “Chatty” offering a cute-little Keelback present to me.)

      https://thailandsnakes.com/red-necked-keelback-venomous-mildly-dangerous/

      Doctor Krista, It’s possible what we are looking at is a cat recovering from a bite, or sting, on the left nostril by a snake, scorpion, hornet, spider etc.

      I know from personal experience that such wounds provoke Type 4 cell-mediated immune responses, (cf. acute inflammatory antibody responses) and so are very slow to heal. (My neighbour was blinded in one eye by reaction to a Hornet sting.)

      With neoplasia, I’d expect this cat to be inappetent and “ill”, but she’s bright, eating well, and purring loudly by my side as I type. So I’m leaning to the insect, arachnid, snake bite, or sting idea for now.

      It’d be nice to have the luxury of lab-work and histology, if it were available and reliable, but I’m old-school trained, and content diagnosing on sensory data alone.

      I certainly considered your Pemphigus differential, but she would have responded very well to the prednisolone 2.5mg/day according to this paper and others:

      https://www.veterinary-practice.com/article/feline-pemphigus-foliaceus

      Thank you for helping me brainstorm 🙂

      I will update you on her recovery.

      Colin

2. 

   Colin Post author

   Here’s an update on what “Princess” looks like today, after 3 months in my care.

   Desperate for progress last week, I sedated her; cleaned up her face, trimmed her whiskers, and extracted all her remaining teeth, (there were 8, not four, with their roots, see snap attached,) just in case it’s an atypical case of “screaming cat-mouth”. Which is caused by feeding cats dry cat-food, and packets of Monsanto pet-sludge, instead of what Carnivores were created to eat: Raw meat and bone in the form of whole animals and arthropods.

   She’s still a happy pussy, and eats whatever is put in front of her; suffers occasional calici/FVR snuffles, has mild pharyngitis, but her mandibular LN are now back to normal size, +BUT that nose ulcer is no better,+ and no worse.

   Again, I could not palpate, or see, any polyps in her mouth or nasopharynx, but I don’t discount the likelihood of smaller polyps in her anterior nasal passages causing this. Perhaps as reaction to FVR, sting, trauma etc.

   She’s still head-shy, it’s as tender as it looks, but she likes to rub her face with her front paws, and on objects, as though it itches.

   I’ve ruled out neoplasia because she’s so well in herself, and her lymph nodes returned to normal after an antibiotic course.

   Demodex, ringworm, and mange are common in strays here, and they’re easily cured with gentle application of home-made flours-of-sulphur and ivermectin creams. She’s had all that routine therapy, so I discount those. This is distinctly different from such cases.

   The black specs are food remains, not scabs.

   My differential diagnosis is now, in order of likelihood;

   Nose trauma/FVR that has caused tiny nasal polyps.
   Insect sting, spider, or snake bite inside her oral cavity, or on her face,
   “Screaming cat-mouth” (aka. Commercial “pet food” toxicity. She could have lived on pet food poached from neighbours’ pets.)
   Atopic allergy. (She licks her body fur all over, in long sessions until it’s wet with saliva, despite bathing and de-fleaing her.)
   Cat leprosy, (Mycobacterium from rodents.)
   Rodent ulcer (Ought to have resolved by now.)
   Leishmaniasis. (Very rarely reported but present in SE Asia)

   Suggestions for therapy welcome 🙂

   Colin