Toxoplasma gondii-associated cholecystitis in a cat receiving immunosuppressive treatment

Abstract

A 9-year-old female neutered domestic shorthair cat diagnosed with immune-mediated thrombocytopenia that was treated with prednisolone and cyclosporine, was presented for anorexia, vomiting, increased liver enzymes, and hyperbilirubinemia. Abdominal ultrasound revealed a markedly thickened gallbladder and common bile duct wall. Bile cytology detected severe neutrophilic inflammation and protozoal zoites. Suspected Toxoplasma gondii infection was confirmed by real-time PCR of bile. The cat was treated with clindamycin and ursodeoxycholic acid for 6 weeks, recovered and remained stable for 2 years despite ongoing immunosuppressive treatment. Thereafter, the cat was presented with suspicion of intestinal lymphoma, and recurrence of toxoplasmosis was diagnosed. Following treatment with clindamycin and prednisolone over 4 weeks the cat was euthanized. This is the first report of Toxoplasma gondii zoites detected in bile fluid from a cat with cholecystitis. Pathogenesis of toxoplasmosis in cats is still not fully understood. Although immunosuppression can represent a relevant predisposing factor, other factors, such as virulence of the parasite and genetic polymorphism of the host, can also play an important role. Toxoplasmosis should be included as a differential diagnosis in cats developing clinical signs of an inflammatory disease while receiving immunosuppressive treatment.

Zusammenfassung

Eine 9-jährige, weiblich-kastrierte Europäisch-Kurzhaar-Katze, die aufgrund einer immunmediierten Thrombozytopenie mit Prednisolon und Ciclosporin behandelt wurde, wurde aufgrund von Anorexie, Erbrechen, erhöhter Aktivität von Leberenzymen und Hyperbilirubinämie vorgestellt. Die sonographische Untersuchung des Abdomens zeigte eine deutlich verdickte Wand der Gallenblase und des Gallengangs. In der zytologischen Untersuchung der Galle waren eine hochgradige neutrophile Entzündung sowie protozoäre Zoiten vorhanden. Eine Real-Time-PCR der Galle bestätigte die vermutete Toxoplasma gondii-Infektion. Die Katze wurde über 6 Wochen mit Clindamycin und Ursodesoxycholsäure behandelt, erholte sich und blieb trotz weitergeführter immunsuppressiver Behandlung 2 Jahre lang unauffällig. Danach wurde Verdacht auf ein intestinales Lymphom gestellt und ein Rezidiv der Toxoplasmose diagnostiziert. Die Katze wurde mit Clindamycin und Prednisolon therapiert und 4 Wochen später euthanasiert. Dies ist der erste Bericht über den Nachweis von Toxoplasma gondii-Zoiten in der Galle von einer Katze mit Cholezystitis. Die Pathogenese der Toxoplasmose bei Katzen ist noch nicht vollständig geklärt. Obwohl eine Immunsuppression einen relevanten Prädispositionsfaktor darstellen kann, können auch andere Faktoren, wie die Virulenz des Parasiten und der genetische Polymorphismus des Wirts, eine bedeutende Rolle spielen. Toxoplasmose sollte bei Katzen, die während einer immunsuppressiven Behandlung klinische Anzeichen einer entzündlichen Erkrankung entwickeln, als Differenzialdiagnose berücksichtigt werden.

Key words

Prednisolone - cyclosporine - cholecystitis - immunosuppression - toxoplasmosis - feline

Schlüsselwörter

Prednisolon - Cyclosporin - Cholezystitis - Immunsuppression - Toxoplasmose - Katze

Publikationsverlauf

Eingereicht: 11. Januar 2019

Angenommen: 29. Mai 2019

Artikel online veröffentlicht:
06. Dezember 2019

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