08/27/2026
Cheeto is a super sweet kitty that presented for not eating at home. An indoor only cat, Cheeto had no known toxin exposure. However his owners were aware of his curious nature and wouldnāt put it past Cheeto to eat something that wasnāt quite food - perhaps a toy, string or object!
Cheeto was hospitalized for evaluation and diagnostics. He had a high fever and bloodwork revealed an elevated white blood cell count, meaning he had infection somewhere. Given his history we were actually quite concerned he had eaten something causing a blockage in his intestines. His radiographs however we not the āslam dunkā obstructive pattern. In fact, they looked a bit hazy.
The hazy appearance, or loss of serosal detail, on abdominal radiographs raises concern for free fluid. In a cat as young as Cheeto, something that often comes up on our list of rule outs in FIP (feline infectious peritonitis). FIP is caused by a mutation in a coronavirus specific to cats. While most cats in large populations ā shelters, catteries, and barns ā are exposed to the coronavirus few will develop disease. A specific mutation must occur to result in FIP. FIP occurs in two forms, wet and dry. The wet form causes fluid build up in the chest and abdomen while the dry form results in granulomatous lesions on major organs. In either case, prognosis has historically been guarded. Until recent years, there was no effective treatment and the average survival time in diagnosed cases was 9 days.
Not wanting to assume the worst, we started supportive care for Cheeto. The first day things were looking up, but as quickly as he improved Cheeto back tracked. After much discussion, the decision was made to take Cheeto into exploratory surgery. We were planning to inspect the abdomen, hoping for a foreign body that could easily be removed. Things didnāt go quite as planned. Cheeto did not have anything lodged in his intestines. However, we came across a very unusual finding. A dark, hard pea size nodule was attached to the pancreas but did not have the appearance of the rest of the pancreas. After a few minutes of weighing pros and cons, we went headfirst into removing it. Through careful dissection, and great care to avoid touching/inflaming the pancreas, the nodule was successfully removed. We sent it for histopathology and nervously waited.
Much to our surprise and delight, Cheeto seemed to feel better. Initially, our thoughts were that this was a pancreatic abscess, sequelae to a bout of severe pancreatitis. It seemed as though removing it also removed a source of infection. A few days later our current theory was proven wrong. The nodule was actually a distorted lymph node and within the node findings were consistent with FIP ā one of our early rule outs! FIP can be extremely challenging to diagnose. We do not have a simple blood test that can screen for FIP, we can check coronavirus titers but this does not translate to disease state. The histopathology we used is one of the most accurate forms of diagnosis, although in most cases we do not come across something obviously unusual to sample.
With a diagnosis in hand we reached out to Cheetoās owners. Again, Cheeto was doing great at home. He appeared to be making a full recovery. In the past, there was no effective treatment for FIP but thankfully times have changed and there are antiviral medications available. These drugs are now accessible in many countries and have been shown to be safe and effective (through clinical studies), although they can be expensive.
Current recommendations are to treat for 12 weeks to allow full clearance of the disease. This can seem a long time but gives cats the best chance of recovery. It may be that shorter courses can be recommended in the future but for now 12 weeks of treatment is required. Different types of FIP require different amounts (dosages) of antiviral medication, FIP cats showing neurological and/or ocular signs being treated with higher dosages. However, there is variation in how cats respond, and adjustments may be needed during the treatment period.
We are happy to report that Cheeto completed his full course of treatment with flying colors! He is enjoying his life and has shown no more signs of illness. Studies have shown that cats successfully treated for FIP with modern antivirals achieve permanent, lifelong remission in 80% to 90% of cases. Once a cat passes the crucial 12-week (84-day) post-treatment observation window without a relapse, their chances of living a happy, full life is great.
