Académique Documents
Professionnel Documents
Culture Documents
Case report
Abstract Acute systemic toxoplasmosis was diagnosed in a 45-year-old, male, Domestic Short Hair cat, which
had been on cyclosporine A immunomodulatory therapy for feline atopy, over an 8-month period. Cyclosporin A
(CsA) has shown promising results as a immunosuppresive agent in the cat for the treatment of eosinophilic
plaque and granulomas, allergic cervico-facial pruritus, feline atopy and other immune-mediated dermatoses.
However, inhibition of T-lymphocyte function by CsA is believed to have predisposed this cat to the development
of a newly acquired, acute Toxoplasma gondii infection, as characterized by severe hepatic and pancreatic pathology in conjunction with the heavy parasite load demonstrated on immunohistochemical (IHC) stains for
T. gondii. Cats on CsA therapy appear to be at risk of developing fatal systemic toxoplasmosis.
Keywords: cyclosporin A, feline atopy, immunomodulatory therapy, Toxoplasma gondii, toxoplasmosis.
I NTRO D U CTI ON
Feline atopy is a multisystemic syndrome characterized by pruritic, frequently nonlesional dermatitis and/
or respiratory disease, with gastrointestinal symptoms
and ocular signs being less common.15 The basis for
the diagnosis of feline atopy currently relies on the
demonstration of a compatible history and clinical
signs, and ruling out other causes of pruritus including
flea-bite hypersensitivity and food hypersensitivity.5
Unlike other species, there is no well-documented
genetic component to atopy in the cat and interpretation of the results of either intradermal or serological
testing is controversial.26 Identifying allergens responsible for the clinical disease can be extremely difficult
and there are no controlled studies of the response to
immunotherapy, with some cats not responding well to
conventional therapies (ectoparasitic prophylaxis, control of secondary infections, glucocorticoids, antihistamines, essential fatty acids, restoring and maintaining
epidermal barrier function, dietary management).2,5,7
CASE
The feline patient was a 45-year-old, neutered, male,
Domestic Short Hair, originating from a single-cat
household and fed a commercial diet. The cat lived predominantly indoors but was known to scavenge outdoors. In 1999, the cat had presented with alopecia,
erythema with some papules on the ventral abdomen,
associated with over-grooming. A full clinical examination had failed to reveal any abnormalities other
than these dermatological signs. Microscopic examination of skin scrapings did not reveal mites, mite eggs or
faecal pellets, and fungal cultures produced no fungal
growth. Haematology, serum chemistry and urinalysis
assays were all within normal parameters. There was
no response to an 8-week lamb-based elimination diet
trial (LB, Iams UK Ltd, Crawley, UK) or ectoparasitic
exclusion. A diagnosis of feline atopy was made and in
light of this, intradermal and serological tests were
advised to try and identify allergens to include in an
immunotherapy vaccine.
The cat was sedated with medetomidine (Domitor,
Pfizer Ltd, Sandwich, UK) and an intradermal test
performed using aqueous allergens (Greer Laboratories Inc, Lenoir, NC, USA). The intradermal test was
carried out according to recognized criteria with Dermatophagoides farinae and D. pteronyssinus allergens
at 1/10 000 w/v, flea at 1/1000 w/v, other allergens at
1000 PNU mL1 and histamine at 1 in 100/000 w/v.
Other allergens included cat dander, mattress dust,
sheep epithelia, mixed feathers, kapok, birch, alder,
beech, sycamore, poplar, oak, willow, elm, privet,
195
196
RD Last et al.
D ISCU SSIO N
The visceral distribution and severity of microscopic
lesions is somewhat different in acute systemic toxoplasmosis and recrudescent infections in adult
cats.10,23,24 In acute disease following ingestion of tissue
cysts or oocysts, lesions tend to be most prominent in
the mesenteric lymph nodes, liver, pancreas and lungs,
2004 European Society of Veterinary Dermatology, Veterinary Dermatology, 15, 194 198
ACKN OWLEDGE ME NT S
We are grateful to Aiden Foster for all the assistance
with this case and preparation of the manuscript. This
study is supported in part by a National Institute of
Health Grant (A147730 to Yasuhiro Suzuki).
REFEREN C E S
1. Roosje PJ, Thepen TH, Rutten VPMG et al. Feline
atopic dermatitis: a review (Abstract). Veterinary Dermatology 2000; 11 (Suppl. 1): 12.
2. Foster A. Diagnosing and treating feline atopy. Veterinary Medicine 2002; 97: 226 40.
3. Power H. A practitioners approach to allergic skin disease in cats. Proceedings of the 17th Annual Meeting of
the European Society of Veterinary Dermatology/European College of Veterinary Dermatology. Copenhagen,
2001: 79 86.
4. Prelaud P, Gilbert S. Atopic dermatitis. In: A Practical
Guide to Feline Dermatology. France: Merial, 1999.
5. Scott DW, Miller WH, Griffin CE, eds. Small Animal
Dermatology, 6th edn. Philadelphia: W.B. Saunders,
2001; 601 8.
6. Wassom DL, Grieve RB. In vitro measurement of canine
and feline IgE. A review of Fc epsilon R1 alpha-based
assays for detection of allergen-reactive IgE. Veterinary
Dermatology 1998; 9: 173 8.
7. Guaguere E. Cyclosporin A a new drug in the field of
veterinary dermatology. In: Proceedings of the Spring
Meeting of the British Veterinary Dermatology Study
Group 2001: 23 34.
8. Center SA. Acute hepatic injury: hepatic necrosis and
fulminant hepatic failure. In: Gulford WG, Center SA,
Strombeck DR. et al. eds. Small Animal Gastroenterology, 3rd edn. Philadelphia: W.B. Saunders, 1996:
683.
9. Jones TJ, Hunt RD, King NW, eds. Veterinary Pathology, 6th edn. Baltimore: Williams & Wilkins, 1996:
555 61.
197
198
RD Last et al.
27. Chappell LH, Wastling JM. Cyclosporin A. Antiparasitic drug, modulator of the host parasite relationship
and immunosuppressant. Parasitology 1992; 105 (Suppl.):
S25 40.
28. Garon CLG, Scott MA, Selting KA et al. Idiopathic
thrombocytopaenic purpura in a cat. Journal of the
American Animal Hospital Association 1999; 35: 464
70.
29. Silverman JA, Hayes ML, Luft BJ et al. Characterization of anti-toxoplasma activity of SDZ 215 918, a
cyclosporin derivative lacking immunosuppressive and
peptidyl-prolyl-isomerases inhibiting activity: possible
role of a P glycoprotein in toxoplasma physiology. Anti-
Rsum Une toxoplasmose aige gnralise a t diagnostique chez un chat europen, mle g de 45 ans,
qui tait en traitement pour une atopie avec la cyclosporine A depuis 8 mois. La cyclosporine A (CsA) est un
agent immunomodulateur qui a donn des rsultats encourageants dans le traitement des plaques et des granulomes osinophiliques du chat, du prurit cervico-facial et dautres dermatoses immunologiques. Cependant,
linhibition des lymphocytes T par la CsA est probablement responsable du dveloppement de linfection gnralise par Toxoplasma gondii chez ce chat, avec une hpatite et une pancratite svre, associe la prsence de nombreux parasites, dmontre par des marquages immunohistochimiques spcifiques. Les chats recevant de la CsA
semblent tre risque pour le dveloppement dune toxoplasmose systmique.
Resumen Se diagnostic una toxoplasmosis sistmica aguda en un gato macho europeo de pelo corto de 45
aos, que haba recibido durante 8 meses una terapia inmunomoduladora con ciclosporina A para la atopia
felina. La ciclosporina A (CsA) ha mostrado resultados prometedores como agente immunosupresor en el gato
para el tratamiento de la placa y granuloma eosinoflicos, prurito alrgico crvico-facial, atopia felina y otras
dermatosis inmunomediadas. Sin embargo, se cree que la inhibicin de la funcin de linfocitos T por CsA puede
haber predispuesto este gato al desarrollo de una nueva infeccin aguda por Toxoplasma gondii, caracterizada
por una grave lesin heptica y pancretica, junto a una elevada carga parasitaria mostrada con tinciones
inmunohistoqumicas (IHC) para T. gondii. Los gatos sometidos a terapia con CsA parecen encontrarse predispuestos al desarrollo de una toxoplasmosis sistmica fatal.
Zusammenfassung Bei einer 4 5 Jahre alten, mnnlichen Europisch Kurzhaar Katze, die immunmodulatorische Therapie mit Cyclosporin A zur Behandlung feliner Atopie ber einen Zeitraum von 6 Monaten erhielt,
wurde akute systemische Toxoplasmose diagnostiziert. Cyclosporin A (CsA) hat vielversprechende Resultate als
immunsuppressives Medikament zur Behandlung von eosinophilen Plaques und Garnulomata, allergischem
cervico-facialem Juckreiz, feliner Atopie und anderen immun-mediierten Hauterkrankungen gezeigt. Man
nimmt jedoch an, dass die Hemmung der T-Lymphozyten-Funktion durch CsA diese Katze fr die Entwicklung
einer neu erworbenen, akuten Toxoplasma gondii- Infektion prdisponiert hat. Diese Toxoplasma gondiiInfektion wurde durch schwere Leber- und Pankreasvernderungen in Verbindung mit einer starken Parasitenlast,
die durch immunhistochemische (IHC) Frbungen fr T. gondii nachgewiesen wurde, gekennzeichnet. Katzen,
die mit CsA behandelt werden, scheinen Gefahr zu laufen, fatale systemische Toxoplasmose zu entwickeln.
2004 European Society of Veterinary Dermatology, Veterinary Dermatology, 15, 194 198