tpvets_logo.jpg (2726 bytes)TOA PAYOH VETS

Date:   12 March, 2015
Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits


Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS

CASE 1 - 2001. The Cat Has Eosinophilic Ulcers

Case written: 21 Jan 2001
Case updated: 12 March, 2015

An adolescent cat with the most stinking stench of bad breath was brought into the veterinary clinic. 

"Young cat with profuse salivation and bad breathYoung cats don't usually have halitosis," mumbled Nurse Ann. This cat perfused the air with an overpowering bad smell. She had experienced all sorts of necrotic rotting smells in her five years at the veterinary clinic. And she thought she had experienced all. 

 Saliva was drooling from the mouth. A very sticky coat glued onto the matted hairs of the neck and the front legs. "It looked like the cat has ingested something poisonous," continued Nurse Ann as she registered the case.

Groomer Ken had a look. "Looks like the cat had been bitten by a rat, Mrs Lam," he said, "there's two small bleeding ulcers on the upper lips, near the canine teeth. She's got rodent ulcer"

"You mean that the rat bit the cat causing ulceration in the upper lip?' asked Mrs Lam who had brought in the cat.  Mrs Lam was not surprised as this was a stray cat and there were a few big rats seen at the hawker stalls in the wet market of Sembawang. Where's there food or exposed garbage, there's rats. A rodent ulcer in the cat. This was the first time she knew about this. Groomer Ken looked serious and nodded his head.

"Rodent ulcers are not caused by rat bites, Mrs Lam," I said to Mrs Lam after she had settled down in the consultation room, "they are slow healing ulcers, sometimes called indolent ulcers. The cat requires a lot of nursing care." 

Slow healing meant a long period of veterinary treatment and of course, a higher veterinary bill. Mrs Lam was worried about the costs.  "She's only a stray cat," said Mrs Lam. "Please lower your veterinary fees." 

Every time she would bring in a stray cat and she would say the same about the high veterinary fees in Singapore's private veterinary clinics compared to the government clinic at Kampong Java Road.  Actually, the fees were as low as could be if the private clinics did not want to lose out to the large subsidised government "Animal Infirmary" which was doing a roaring business.
"There are two small upper lip ulcers," I confirmed. "It is possible that the cat is suffering from the Eosinophilic Granuloma Complex. There are three separate skin conditions making up the Eosinophilic Granuloma Complex and a cat may have any or all of them.  The cause is said to be the eosinophils releasing chemicals which attack her own collagen tissues."

"What are eosinophils?" Mrs Lam asked.

"The eosinophils are one type of white blood cells produced by the cat to get rid of the invading parasites, such as cat fleas. The eosinophils in this cat attacked the cat's tissues too."

Mrs Lam looked blankly.  She could not understand much of what was being explained. It was just too much medical jargon.

"There would be ulcers in the tongue," I gripped the cat's mouth with my thumb and forefinger of my right hand to scrutinise the extent of the ulcerations.

The cat clamped her jaws tight as if she had tetanus or locked jaw. She warned me with a raise hand that she claw me if I persevered but the claws were not out. This was a gentle grey Siamese Cross with bright yellow eyes.  I would not want to forcibly open her mouth as it must be very painful with infected ulcers. 

The air conditioning in the consultation room dispersed the smell of halitosis.   The hairs below the cat's neck were a thick hardened mass because the cat could no longer groom herself, being sick.  Excessive saliva drooled uncontrollably from her mouth.

"Why is it called the Eosinophilic Granuloma Complex?" Mrs Lam's daughter of 17 years and studying in the top junior college pronounced the name of this disease.

I elaborated: "There are three different manifestations of this disease. These three are called: the rodent or indolent ulcer, the eosinophilic plaque (a raised thickened raw area of skin usually on the belly, inner thigh or throat area) and the eosinophilic granuloma (a swollen lower lip or chin or a long, narrow lesion running down the back of the thigh).  The plaques can be very itchy. Looks like the throat area is affected by the eosinophilic plaque."  

"I am going out to get some fresh air," Mrs Lam excused herself for a few minutes to smoke before coming back. It was just nauseating for this career lady who cared much for stray cats.  It could become prohibitively expensive since she took care of so many stray cats around the neighbourhood of Sembawang, one of the few areas untouched by the rapid pace of urbanization in Singapore.   

I put the cat on another table where there was natural ventilation so that further discussion could take place.

"Can Jasmine be cured?" asked Mrs Lam.

"Usually one injection of an anti-inflammatory drug will be effective." 

"Will the disease recur?"

"Yes, if the allergen causing this complex has not been eliminated. It could be due to flea allergy as this stray cat would be in contact with other cats infested with fleas. Presently, no flea is found. If the disease is due to food allergy, the anti-inflammatory treatment may not be effective if the cat is fed the same type of food."  Stray cat caregivers leave canned and dry food on certain areas to feed the strays. 

"How much is the cost of treatment?"

"As you can't confine the cat for several days, the cost of warding will add up to a large amount.  Antibiotic injections are needed in this case, to eliminate the foul smelling bacteria in the mouth ulcers. The cat will need to be tranquilised to bathe her and remove the hardened fur on the neck and front legs. Ken would have to do a lot of nursing and that means additional costs."

"But this is only a stray cat! You should charge less. I can't bring her to the SPCA as she would be euthanised. There are too many stray cats." 

This would be a money losing case. But should I think in terms of dollars and cents?   

"We have to charge a small amount," I said .A private veterinary surgery needs to sustain its profitability as it has to pay the staff and overheads .

If I did not treat the case at a loss, what would happen to this young cat?
She would die a horrible death. 

"I will minimize the cost. Let's fix it at one hundred and twenty dollars.  The cat will stay at least fourteen days of stay in the surgery."

The cat still objected to her mouth being opened.  She had a good appetite and was alert, always meowing when she saw the kennel staff and Dr Chua.  Most likely an adolescent cat.  Within 2 days, the antibiotic had eliminated the bacteria and there was no bad smell of the breath.

Cat: Ulcers in tongue, hard palate, upper lips
The rodent ulcers in the tongue took a few days to heal.  There was a long streak of ulcer in the middle of the tongue.   A small eosinophilic granuloma could be seen on the hard palate, the roof of the mouth.

Should I give an anti-inflammatory injection now? To expedite the healing of the ulcerated tongue? The cat was eating.

Would more ulcers form if I did not give this injection recommended for rodent ulcer treatment?

The throat area was a sticky mass of hair. This area appeared to be affected by the eosinophilic plaques. Fortunately, there was no inflammation or ulceration there.

The first thing to do is to bathe the cat. The cat did not like water. That's their nature unless they had been used to water from a young stage.

A light tranquiliser injection was given and she was bathed.  No fleas were found.  But one flea bite could cause this complex.  Three days later, Jasmine looked good. 

Cat: Rodent ulcer healing 7 days after treatmentThe rodent ulcer in the upper lip and the tongue ulcers had almost healed.  The skin of the throat area was not ulcerated. 

Jasmine would need a home rather than be let out wandering again and get infested by fleas and suffering from rodent ulceration again. 

Would Mrs Lam adopt this cat since she had twenty in the HDB (Housing & Development Board) apartment? The HDB prohibits keeping of cats in the HDB apartment and if somebody complains, there will be legal action to evict all the cats. 

CASE 2 - 2009. The Unvaccinated Young Cat Has Tongue Ulcers
Case written: 14 May 2009
Case updated: 12 March, 2015

"My cat has bad breath," Mohammed put his young cat on my consultation table. "Saliva keeps dripping out of her mouth. She was treated by you for fever 7 days ago. What happened now?"

I checked the medical records. This cat was not vaccinated. Many Singapore cat owners don't bother to vaccinate their "common" cats. Food, water and a home. What more does the stray cat want?
This is part of the pragmatic mindset of older Singaporeans when they adopt a stray kitten and rear them to young adults. If there is caterwauling, they will get the cat spayed or neutered.

However, this cat had encounters with outside stray cats. She came home with high fever 7 days ago. A viral infection was suspected. No blood tests were done as the average cat owner wants just the least veterinary cost in this economic recession.  The young cat probably got infected with a herpes virus. Now, tongue and gum ulcers present themselves.   

"Can the cat be vaccinated now?" the couple in their 40s asked when I told them that vaccination would have prevented many common cat viral diseases. "Not now," I said. "It is too late."

I warded the cat for 3 days for treatment. The cat went home with no more bad breath and drooling. "There is some healing as the ulcers are not so red. But you can't expect immediate healing. It will take a few more days before the ulcers disappear," I advised the owner.

Singapore in the 2009 has a much sophisticated and educated population of cat owners and except for stray cats, there are very few cases of mouth ulcers as they are usually vaccinated or kept isolated at home.


Video: Recurrent mouth ulcers in a Singapore cat - not groomed


Case in 2015
A case of feline eosinophilic granuloma complex in a stray cat in Singapore in March 12, 2015. This ferocious stray cat had eosinophilic ulcer around 4 weeks ago. Dental scaling was done. Now he had drooling and anorexia. Eosinophilic granulomas at the back of his mouth, bilateral raised swellings were seen.  He was given methyl prednisolone SC injection. He recovered. 

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All rights reserved. Revised: March 12, 2015
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