Case Report: Clinical Remission in a Cat With Severe Bilateral Eosinophilic Keratitis Receiving Combined Immunosuppressive Therapy (Triamcinolone Acetonide and Tacrolimus)

Abstract

A 2-year-old domestic shorthair cat was examined for severe keratitis of 10 months duration, non-responsive to 0.1% dexamethasone q8-12h. Patient and owner compliance were poor given ocular discomfort and hiding behavior. On presentation, both eyes (OU) had severe ulcerative keratitis that masked examination of deeper structures and resulted in absent menace response OU. Corneal cytology was consistent with eosinophilic keratitis (EK) OU. Initial therapy included subcutaneous triamcinolone acetonide injection (0.2 mg/kg), 0.3% ciprofloxacin OU q12h, and two compounded drugs started 5 days later upon receipt: 0.5% tacrolimus OU q6h, 0.5% cidofovir OU q12h. Visual behavior and ocular comfort were reportedly much improved within 24 h. At the first recheck (Day 11), patient and owner compliance were reported to be excellent, menace response was positive OU, and keratitis was dramatically reduced OU with absent fluorescein uptake. Subcutaneous triamcinolone acetonide was repeated (0.2 mg/kg), ciprofloxacin was discontinued, cidofovir was continued q12h, and tacrolimus was slowly tapered (q8h × 3 weeks then q12h). Keratitis was nearly 100% resolved at the second recheck (Day 38); cidofovir was discontinued and tacrolimus was slowly tapered (q12h × 1 week, q24h × 4 weeks, q48h × 4 weeks) then discontinued. A third recheck (Day 101) confirmed clinical remission OU, and disease did not reoccur within a 1 year follow up period (photographic documentation by owner). In sum, adjunct use of triamcinolone acetonide greatly improved therapeutic compliance and helped control severe EK in a rapid and effective manner.

Kinetics and minimal inhibitory concentrations of ceftiofur in tear film following extended-release parenteral administration (Excede®) in dogs

“…While the ocular bioavailability of topical administration is poor given efficient washout by tears ( 1 – 3 ), parenteral administration could be considered as a form of sustained release at the ocular surface through lacrimal gland diffusion and conjunctival leakage ( 10 ). Further, systemic drug administration could help improve patient ( 27 ) and owner compliance, especially in cases of bacterial keratitis where multiple medications have to be applied as often as every 1–2 h ( 28 ). Ceftiofur represented an ideal candidate for adjunct therapy of bacterial keratitis given the sustained-release profile of ceftiofur crystalline-free acid in dogs ( 12 ).…”

Prevalence and characteristics of ocular diseases in Sphynx cats: A retrospective assessment (2012–2021) and comparison withnon‐Sphynxcats

“…In contrast, a diagnosis of “corneal ulcer” was made when no specific etiology could be identified. A diagnosis of “eosinophilic keratitis” was based on supportive corneal cytology, as previously described 14 . Last, for cats diagnosed with entropion, cases were excluded if the underlying etiology was spastic, secondary to age‐related orbital fat loss/enophthalmos, or cases of medial lower eyelid entropion in brachycephalic cats.…”

“…A diagnosis of "eosinophilic keratitis" was based on supportive corneal cytology, as previously described. 14 Last, for cats diagnosed with entropion, cases were excluded if the underlying etiology was spastic, secondary to age-related orbital fat loss/ enophthalmos, or cases of medial lower eyelid entropion in brachycephalic cats. During the pre-operative assessment of the cat, the severity of entropion was graded by the clinician using the Wyman method ("rule of thumb"), subjectively evaluating the amount of outward eyelid pulling required to expose the eyelid margin.…”

Feline Eosinophilic/Proliferative Keratitis: A Retrospective Study (2016-2021)

“…Feline eosinophilic keratitis (FEK), also known as proliferative keratitis, proliferative eosinophilic keratitis, or eosinophilic plaque, is a slowly progressive infiltrative keratopathy that starts with a progressive and superficial vascularization of the perilimbal cornea and is characterized by the infiltration of the corneal epithelium and stroma by mast cells, eosinophils, neutrophils, lymphocytes, and plasma cells (Ahn et al 2010, Dean and Meunier 2013, Edwards et al 2015, Lucyshyn et al 2021. Although an association between FEK and feline herpes virus type 1 (FHV-1) has been suggested in cats, the precise pathogenesis of FEK remains unknown, and the cellular profile is typically consistent with type I (IgE-mediated) or type IV (Hodges 2005, Romaneck andSebbag 2021). The literature also contains views suggesting a connection between this condition and the feline eosinophilic granuloma complex (Chisholm 1989).…”