RCVS Specialist in Feline Medicine, Professor Danielle Gunn-Moore from Edinburgh University, delivered a practical webinar on how to successfully diagnose and manage triaditis in cats by using her very own Bengal female cat  ‘Ninny’ as a perfect example of how to approach these challenging cases. It also becomes clear listening to Ninny’s amazing story that feline triaditis does not often present purely as a singular condition but usually develops as a result of ongoing gastrointestinal problems, and once triaditis has been established a myriad of other conditions may then develop including diabetes, lymphoma and hepatitis.

Ninny’s story started when she was a kitten, having developed large bowel diarrhoea probably as a result of Tritrichomonas . Ever since this episode, she developed a sensitive stomach with intermittent bouts of vomiting and diarrhoea. However, at 4 years old the vomiting and diarrhoea increased in frequency so Danielle decided to perform faecal analysis and blood tests on Ninny. The blood tests revealed only mild elevations in liver enzymes and no obvious infectious causes were found on faecal analysis.

At this point, Danielle wanted to warn us about the use of PCR panels on faeces to ascertain the presence of infectious organisms. It has been shown that in 50-60% of feline faecal samples analysed, Coronavirus and Clostridium will be present. However, these are unlikely to be clinically significant so it is always important when interpreting these results that the full clinical picture is taken into account prior to any treatment.

Given there was nothing of great significance found on bloods or faecal analysis Danielle opted to place Ninny on a diet trial and probiotics. Danielle advised that a diet trial needs to be carried out for 2-4 weeks using a single source protein such as chicken or alternatively by using a commercial diet with a hydrolysed protein. Danielle also explained that probiotics have been shown to be effective, with data in cats demonstrating a reduced time to recovery in acute gastroenteritis, a decrease in naturally occurring disease in kittens and a decrease in numbers of Clostridium perfringens.

Ninny did well for 2 years but unfortunately suffered a relapse and at this point, faecal analysis showed the presence of Giardia which was treated successfully with fenbendazole. A year after this Ninny deteriorated again and bloods revealed a marked elevation in her liver enzymes.  She also had an elevated FPLi and an abdominal ultrasound revealed findings consistent with pancreatitis. Her folate and B12 were also decreased indicating small bowel disease and pancreatitis. Endoscopy was also performed in order to obtain intestinal biopsies where a diagnosis of inflammatory bowel disease (IBD) was also made. Tricut biopsies and bile aspiration were also performed which eventually led to a diagnosis of triaditis, a combination of inflammatory bowel disease ( IBD), pancreatitis and cholangitis.

Each entity of triaditis needs to be taken into account when considering how to manage these cases. For example, IBD usually develops as a result of an antigenic stimulus causing an inflammatory response. Removing this stimuli by feeding an appropriate hypoallergenic diet alongside immunosuppressives such as prednisolone is the best course of action for treating IBD. If, however, the affected cat is diabetic, chlorambucil can be used as an alternative to prednisolone. Supplementation with B12 and folate will also be necessary due to their low levels in many of these cases. The hepatopathy is also best treated with SAMe and the pancreatitis can be managed symptomatically by administering pain relief, maropitant and omeprazole.

Danielle went ahead and managed Ninny as stated in the above paragraph and she did really well for a further seven years. Unfortunately, at 14 years old,  she then went on to develop gastrointestinal and pancreatic lymphoma, known to be a potential consequence of plasmocytic-lymphocytic inflammatory bowel disease. At this point in the story, I had naturally assumed this may well be the end of the line for Ninny but this was very much not the case. Danielle went on to treat her with prednisolone and chlorambucil where she responded really well. However, one year later she developed an E.coli urinary tract infection(uti) and bladder lymphoma which amazingly appeared to resolve on the treatment of the uti. Despite all of Ninny’s problems including the development of diabetes and congestive heart failure, she went on to survive for another incredible four years. Sadly at 18 years she eventually succumbed and was put to sleep as a consequence of a squamous cell carcinoma that had developed on her jaw.

This was the tale of a beautiful cat ‘Ninny’  bravely told by her very devoted owner, Danielle. Ninny’s story had so many twists and turns which I’m sure many of us are familiar with in dealing with our cases in practice. Her story has taught me a lot about how to manage feline triaditis as well as to always consider the potential consequence of this disease and the other conditions it may lead to. Danielle offered much more detailed information on diagnosing and treating feline triaditis which can easily be accessed by watching this webinar. However, the biggest lesson I’ve learnt is that a diagnosis of small cell lymphoma which may develop as a consequence of feline triaditis is not always necessarily a death sentence. These cats can do really well with appropriate treatment and in Ninny’s case gave her an additional four years of good quality life.

To watch this webinar in full, just click here.