A 3.5 year-old cat was admitted to the University of Melbourne Veterinary Teaching Hospital for chronic vomiting. Abdominal ultrasonography revealed a focal, circumferential thickening of the wall of the duodenum extending from the pylorus aborally for 3 cm, and an enlarged gastric lymph node. Cytology of fine-needle aspirates of the intestinal mass and lymph node revealed an eosinophilic inflammatory infiltrate and numerous extracellular septate acute angle branching fungal-type hyphae. Occasional hyphae had globose terminal ends, as well as round to oval blastospores and germ tubes. Candida albicans was cultured from a surgical biopsy of the duodenal mass. No underlying host immunodeficiencies were identified. Passage of an abrasive intestinal foreign body was suspected to have caused intestinal mucosal damage resulting in focal intestinal candidiasis. The cat was treated with a short course of oral itraconazole and all clinical signs resolved.

Case summary An 8-month-old female spayed Burmese cat was referred for investigation of reduced appetite, reluctance to walk and jump and amaurosis. On serum biochemistry there was severe hypokalaemia and marked elevation of creatine kinase, suggestive of hypokalaemic polymyopathy. The neurological signs were consistent with thiamine deficiency. The cat was negative for the periodic hypokalaemic polymyopathy (PHP) of Burmese cats, and was ultimately diagnosed with a previously undescribed potassium wasting nephropathy requiring ongoing oral potassium supplementation. The response to treatment was excellent and the cat has remained clinically normal over a 12-month follow-up period. Relevance and novel information PHP in Burmese cats has been well described, but all cases to date have been shown to be secondary to a genetic mutation in WNK4, resulting in potassium wasting into the urine. This is the first case report of another potassium wasting nephropathy in a young Burmese cat, with subsequent development of nutritional thiamine deficiency.

HistoryA 4-year-old 6.8-kg (15-lb) neutered male Abyssinian cat was referred because of a 1-week history of anorexia and lethargy. The cat had previously received dexamethasone (0.5 mg/kg [0.23 mg/lb], SC, q 24 h), enrofloxacin (5 mg/kg, [2.3 mg/lb], SC, q 24 h), and IV fluid therapy with saline (0.9% NaCl) solution at a rate 30 mL/kg/h (13.6 mL/lb/h) for the first 8 hours, then 3 mL/kg/h (1.4 mL/lb/h) for 4 days. Urine output was estimated to be low by the referring veterinarian.Physical examination revealed hypothermia (body temperature, 33°C [91.4°F]), a heart rate of 190 beats/min, no heart murmur, weak femoral pulses, slow capillary refill time, tachypnea (60 breaths/min), expiratory dyspnea, diffuse harsh lung sounds, and an abdominal fluid wave.Hematologic evaluation revealed mature neutrophilia (18.3 X 10 9 neutrophils/mL; reference range, 3 X 10 9 neutrophils/mL to 12 X 10 9 neutrophils/mL). Serum biochemical analysis revealed high alanine aminotransferase activity (2,227 U/L; reference range, 10 to 90 U/L) and urea nitrogen concentration (24 mmol/L; reference range, 5.4 to 10.7 mmol/L). Serum lactate concentration was moderately high at 5.9 mmol/L (reference range, 0.4 to 2.5 mmol/L 1 ). The cat had mild hypoalbuminemia, mild hyperbilirubinemia, mild hypocalcemia, hyponatremia (130 mmol/L; reference range, 145 to 158 mmol/L), and hyperkalemia (5.1 mmol/L; reference range, 3.6 to 4.9 mmol/L).Venous blood gas analysis revealed probable mixed metabolic acidosis and respiratory alkalosis, given a pH of 7.21 (reference range, 7.35 to 7.45), base deficit of 11 (reference range, -4 to 2), and PCO 2 of 31.8 mm Hg (reference range, 38 to 51 mm Hg). Systolic arterial blood pressure measured by Doppler ultrasonography was 80 mm Hg (reference range, 110 to 160 mm Hg).Abdominal ultrasonography revealed free abdominal fluid that was subsequently characterized as a modified transudate (total solids concentration, 23 g/L; specific gravity, 1.020), hyperechoic renal cortices, and a medullary rim sign. Thoracic radiographs were obtained (Figure 1).Determine whether additional imaging studies are required, or make your diagnosis from Figure 1-then turn the page →