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Case summary A 13-year-old castrated male domestic shorthair cat was diagnosed with diabetes mellitus based on hyperglycaemia, glucosuria and an elevated plasma fructosamine concentration. The diagnosis followed a 1-month history of lethargy and weight loss, along with a 1-week history of polyuria and polydipsia, which developed after the patient received a long-acting methylprednisolone injection from the referring veterinarian for pruritus. Treatment with velagliflozin was initiated, resulting in excellent glucose control, weight gain and resolution of clinical signs. However, the owner reported diarrhoea that did not improve with dietary modifications, symptomatic treatments or dose reduction of velagliflozin. Consequently, velagliflozin was discontinued after 64 days. Despite discontinuation, the cat remained euglycemic, with plasma fructosamine levels within the reference interval throughout a 175-day follow-up period. According to the Agreeing Language in Veterinary Endocrinology consensus definition, diabetes mellitus remission was confirmed. Relevance and novel information This case report highlights that diabetic remission is achievable in cats treated with SGLT2 inhibitors, as described in human patients with type 2 diabetes mellitus. Plain language summary A cat newly diagnosed with diabetes achieves remission with SGLT2 inhibitor treatment A 13-year-old male castrated domestic shorthair cat was diagnosed with diabetes after showing high blood sugar, sugar in the urine and elevated fructosamine levels. The cat had been lethargic and losing weight for approximately 1 month and was drinking and urinating more than usual for 1 week, which started after receiving a long-acting steroid injection for skin itching. The cat was treated with velagliflozin, a medication that helps lower blood sugar, which led to excellent glucose control, weight gain and disappearance of clinical signs. The cat developed diarrhoea that did not improve with diet changes, supportive treatments or lowering the velagliflozin dose, so the medication was stopped after 64 days. Despite stopping the drug, the cat’s blood sugar stayed normal, and fructosamine levels remained within the normal range during 175 days of follow-up. According to veterinary guidelines, this means the cat achieved diabetes remission. This case shows that remission of diabetes is possible in cats treated with SGLT2 inhibitors, similar to what has been observed in humans with type 2 diabetes.

Case summary A 5-year-old castrated male domestic shorthair cat presented with a 3-month history of weight loss, chronic diarrhoea and vomiting. Examination revealed a large proximal duodenal lesion eventually diagnosed as feline gastrointestinal eosinophilic sclerosing fibroplasia (FGESF) associated with fungal filaments. Histological examination was performed following endoscopic biopsy. Direct examination and mycological culture of the duodenal biopsies revealed the presence of a siphomycetous fungus, which was further identified as Rhizopus microsporus. Treatment with prednisolone and ciclosporin for 3 months led to complete resolution of the clinical signs and marked improvement of the endoscopic lesions. Specific fungal treatment with amphotericin B was poorly tolerated. Relevance and novel information To the best of our knowledge, this is the first report of the characterisation of a siphomycetous fungus associated with FGESF lesions, and the first endoscopic description and diagnosis of FGESF without surgical biopsies. We hypothesise that the presence of R microsporus occurred because of disrupted mucosal integrity.

Case summary A 10-year-old neutered female domestic shorthair cat was presented to our hospital with a 2-day history of anorexia, vomiting and lethargy. The biochemistry panel revealed increased hepatic enzyme activity and serum amyloid A concentration. Haematological values were within reference intervals. An abdominal ultrasound identified a hyperechoic spindle-shaped structure within the common bile duct and a suspected secondary subobstruction, associated with signs of intra- and extrahepatic biliary tract inflammation. During hospitalisation, the cat developed severe and sustained ionised hypercalcaemia. Exploratory surgery was elected as a result of the lack of clinical improvement, despite supportive treatment and suspected retrograde migration of the spindle-shaped structure. Two grass awns were extracted at the junction of an extrahepatic duct and the common bile duct via choledochotomy using intraoperative ultrasound guidance. A stent was then placed in the bile duct to prevent subsequent bile leakage. Histopathology of the liver revealed a moderate neutrophilic and lymphoplasmacytic inflammation with rare bacterial colonies. Escherichia coli was cultured from a bile sample. No specific cause of hypercalcaemia was identified. The cat recovered uneventfully from surgery. Hepatic enzyme activities and hypercalcaemia progressively decreased within a few weeks after surgery and remained within the reference intervals without treatment. Therefore, hypercalcaemia was suspected to be secondary to a foreign body-related granulomatous reaction. Relevance and novel information To our knowledge, only one other feline case report of biliary tract obstruction secondary to a biliary foreign body has been described in the literature. This is also the first case reporting the use of intraoperative ultrasound to localise a vegetal foreign body within the biliary tract of a cat. This case is also unique because of the onset of hypercalcaemia suspected to be secondary to a foreign body-related granulomatous reaction.

Abstract Background Development of a telmisartan-based suppression test may facilitate the diagnosis of primary hyperaldosteronism (PHA) in cats, which remains difficult today. Objectives To develop a telmisartan suppression test (TST) that is safe, and able to suppress aldosterone secretion in healthy cats but not in cats with PHA. Animals Ten healthy cats and 6 cats with PHA. Methods Prospective study using a placebo-controlled crossover design to investigate a TST in healthy cats, and evaluation of TST in cats with PHA. Plasma aldosterone concentration, potassium concentration, and systolic blood pressure (SBP) were measured before (T0), and 1 hour (T1) and 1.5 hours after (T1.5) PO administration of 1 mg/kg of telmisartan, 2 mg/kg of telmisartan or placebo. Results Median age in healthy cats was 3 years old (range, 1-7). In healthy cats, a telmisartan dose of 2 mg/kg significantly decreased aldosterone concentration at T1 and T1.5 compared with T0. Placebo had no significant effect on aldosterone concentration. In cats diagnosed with PHA, a 2-mg/kg dose of telmisartan did not induce any significant change in aldosterone concentration at T1 or T1.5 compared with T0. No adverse effects of telmisartan (e.g., hyperkalemia, systemic hypotension) were observed in any cats. Conclusions and Clinical Importance The oral TST shows promise as a diagnostic test for the diagnosis of PHA in cats.

Abstract Background Limited information is available concerning treatment of ionized hypercalcemia in cats. Hypothesis/Objectives Describe clinical findings in a cohort of cats with persistent ionized hypercalcemia and evaluate long-term tolerance and efficacy of alendronate in these patients. Animals Twenty cats with persistent ionized hypercalcemia of undetermined origin, presented for routine or referral consultation at the teaching hospital of Maisons-Alfort (France). Methods Medical records were retrospectively reviewed. Cats were divided into Group 1 (cats that received alendronate as well as other treatments, n = 11) and Group 2 (cats that did not receive alendronate, n = 9). Survival analysis (Kaplan-Meier method, log-rank test, and Cox proportional hazard models) was conducted to compare time to selected outcomes. Results Azotemia was present in 15 cats (75%). Alendronate treatment was administered and well tolerated during the entire follow-up period (median, 9.5 months; interquartile range [IQR], 6.3; 27) in all cats from Group 1, except in 1 cat that developed severe hypophosphatemia, prompting treatment discontinuation. Univariate analysis determined that alendronate treatment was significantly associated with shorter time to reach a 15% decrease in ionized calcium concentration (iCa) from baseline during follow-up (119 days vs median not reached, P = .02). This association was no longer significant after adjustment for age and initial iCa. Conclusions and Clinical Importance Alendronate overall was well tolerated with chronic use in this cohort, and can be considered a treatment option for persistent ionized hypercalcemia in cats.

Abstract Background The diagnosis of pyelonephritis in cats is challenging and development of a noninvasive and accurate biomarker is needed. Hypotheses Serum amyloid A (SAA) is increased in cats with pyelonephritis, but not in cats with other urinary tract diseases. Animals A cohort of 125 cats (149 observations). Methods This was a prospective study. Group 1 included cats with a diagnosis of pyelonephritis either confirmed by bacterial culture of pelvic urine (Group 1a) or presumed (1b). Group 2 included cats for which pyelonephritis was ruled out (with certainty: Group 2a or judged unlikely: Group 2b). SAA concentration was compared between groups, and accuracy of SAA for the diagnosis of pyelonephritis was calculated using a Receiver Operating Characteristic (ROC) curve analysis. Results Median SAA concentration was significantly higher in Group 1a (86.8 mg/L [73.3; 161.5]; n = 8) than in Group 2a (4 mg/L [1.8; 5.6], n = 19; P < .001) and in Group 2b (5.4 mg/L [3.1; 9.7], n = 113; P < .001). It was also significantly higher in Group 1b (98.8 mg/L [83.1; 147.3]; n = 9) than in Group 2b (P < .001) and Group 2a (P < .001). Optimal diagnostic cut-off for SAA concentration was 51.3 mg/L. yielding a sensitivity of 88% (95% confidence interval: [64%; 99%]) and a specificity of 94% (95% confidence interval: [88%; 97%]). Conclusions and Clinical Importance Measurement of SAA could be used to rule out pyelonephritis in the case of low suspicion of the disease. Increased SAA concentration is suggestive of pyelonephritis despite a lack of specificity.

Abstract Background Immune-mediated polyarthritis (IMPA) is a joint disease common in dogs. Although its prognosis is generally favorable, relapses are frequent, and predictive factors for relapse remain poorly characterized. Objectives To evaluate the outcome of medical management of IMPA in dogs and identify predictive factors for relapse. Animals Client-owned dogs diagnosed with non-associative IMPA between 2010 and 2022 across four veterinary referral centers. Methods This was a retrospective multicentric study. The data collected at the time of diagnosis, including signalment, clinical presentation, imaging, and laboratory findings, and treatments, were analyzed. Relapse was defined as the recurrence of clinical signs, CRP levels above the reference range, or both after remission. Associations with time from remission to relapse were assessed using univariate and multivariable Cox models. Results Among 119 dogs, 114 (95.8%) achieved remission. Among the 85 dogs with relapse data, the median time to relapse was 6.5 months, with relapse rates of 43% at 6 months, 61% at 12 months, and 65% at 24 months. In the multivariable analysis, thrombocytosis (adjusted hazard ratio [aHR] = 5.5 [2.0–15.0]95%, p < 0.001), lymphadenomegaly (aHR = 4.0 [1.5–11]95%, p = 0.006) and lameness (aHR = 3.9 [1.2–12.2]95%, p = 0.02) at initial admission were independently and significantly associated with time from remission to relapse. Conclusion This study highlights a favorable clinical outcome for dogs with non-associative IMPA with high remission rates but substantial relapse risks. Lameness, lymphadenomegaly, and thrombocytosis are associated with a greater risk of relapse.

Abstract Background In a previous study, telmisartan suppressed aldosterone secretion in healthy cats but not in cats with primary hyperaldosteronism (PHA). Hypotheses Telmisartan suppresses aldosterone secretion in middle-aged healthy cat and cats with diseases that may result in secondary hyperaldosteronism, but not in those with PHA. Animals Thirty-eight cats: 5 with PHA; 16 with chronic kidney disease (CKD), subclassified as hypertensive (CKD-H) or non-hypertensive (CKD-NH); 9 with hyperthyroidism (HTH); 2 with idiopathic systemic arterial hypertension (ISH); and 6 healthy middle-aged cats. Methods Prospective, cross-sectional study. Serum aldosterone concentration, potassium concentration, and systolic blood pressure were measured before and 1 and 1.5 hours after PO administration of 2 mg/kg of telmisartan. The aldosterone variation rate (AVR) was calculated for each cat. Results No significant difference in the minimum AVR was observed among groups (median [quartile 1 (Q1); quartile 3 (Q3)]: 25 [0; 30]; 5 [−27; −75]; 10 [−6; −95]; 53 [19; 86]; 29 [5; 78]) for PHA, CKD, HTH, ISH, and healthy cats, respectively (P = .05). Basal serum aldosterone concentration (pmol/L) was significantly higher in PHA cats (median [Q1; Q3]: 2914 [2789; 4600]) than in CKD-H cats (median [Q1; Q3]: 239 [189; 577], corrected P value = .003) and CKD-NH cats (median [Q1; Q3]: 353 [136; 1371], corrected P value = .004). Conclusions and Clinical Importance The oral telmisartan suppression test using a single dose of 2 mg/kg telmisartan did not discriminate cats with PHA from healthy middle-aged cats or cats with diseases that may result in secondary hyperaldosteronism.

Abstract Background Hypoadrenocorticism in cats is uncommonly reported. Most reports consist of cats with hyponatremia, hyperkalemia, or both. Hypothesis/Objectives To describe clinical findings, treatment response, and outcome in cats diagnosed with hypoadrenocorticism, including cats with abnormal and normal serum sodium and potassium concentrations. Animals Forty-one cats with hypoadrenocorticism; 36 with and 5 without abnormal serum sodium and potassium concentrations. Methods Multicenter retrospective observational study. Data for the entire cohort were assessed using descriptive statistics and differences between cats with and without abnormal serum sodium and potassium concentrations were evaluated. Results Median age was 5.7 years (range, 0.2-13.8). Twenty-three (56%) cats were male and 18 (44%) were female. Cats with hyponatremia, hyperkalemia, or both were less likely to have a history of vomiting (P = .01) but more likely to be hypothermic (P = .03), dehydrated (P = .04) or weak (P = .04) on examination, compared with nonhyponatremic and nonhyperkalemic cats. Frequency of hypercalcemia was 31.7%. Exocrine pancreatic insufficiency (EPI) was diagnosed in 4/7 cats tested; all 4 had concurrent cobalamin deficiency. Thirty-five (85.4%) cats survived to discharge. In 2 cats, hypoadrenocorticism occurred secondary to lymphoma. Median survival time (MST) for all-cause mortality was 2035 days (95% confidence interval [CI], 294-4380 days); MST for disease-specific mortality was not reached. Conclusions and Clinical Importance Approximately one-third of cats with hypoadrenocorticism had hypercalcemia. In some cases, hyponatremia and hyperkalemia were not observed. Cats with nonneoplastic associated hypoadrenocorticism that survive initial hospitalization can have a favorable long-term prognosis. Testing for EPI may be warranted in cats with hypoadrenocorticism.

Abstract Background Cholelithiasis is an uncommon and mainly incidental finding in dogs; current literature on this topic is scarce in cats. Hypothesis Report prevalence, clinical presentation, management, and outcome of cholelithiasis in cats. Animals Ninety-eight cats with cholelithiasis. Methods Retrospective multicenter case series. Electronic databases from 3 hospitals were searched for cats diagnosed with cholelithiasis by ultrasonography (US). Cholelithiasis was classified as incidental (IC) or symptomatic (SC) depending on clinicopathological signs, biliary tract US appearance, and presence of another disease potentially explaining the clinical presentation. Multivariate analysis was used to investigate factors associated with clinical expression of cholelithiasis and, within the SC group, survival. Results The observed prevalence of cholelithiasis was 0.99% (95% confidence interval [CI], 0.79%-1.19%) among cats that underwent abdominal US. Cholelithiasis was classified as IC in 41% and SC in 59%. Choleliths found in multiple locations within the biliary tract (odds ratio [OR], 8.11; 95% CI, 2.32-34.15; P = .001) or associated with US signs of obstruction (OR, 18.47; 95% CI, 2.13-2413.34; P = .004) were significantly associated with SC. Concurrent hepatobiliary diseases were suspected or confirmed in 83% of cases with SC. Forty-three cats (74%) with SC survived to discharge. Biliary tract obstruction (BTO) was negatively associated with survival (OR, 13.87; 95% CI, 1.54-124.76; P = .001). None of the cats with IC that had available follow-up (47%) developed clinicopathological signs related to cholelithiasis. Conclusions and Clinical Importance Cholelithiasis is uncommon and can be asymptomatic in cats. Symptomatic cholelithiasis frequently is associated with another hepatobiliary disease or BTO or both. Biliary tract obstruction is associated with poorer outcome.