"Big tangerine" is a 1-year-old male neutered Chinese garden Cat (Felis catus) from a household of four cats (2 Felis catus,2 British Shorthairs). "Big tangerine" was found appetite and weight loss for several weeks. But other cats are normal. On November 15, 2020, he was taken to Guaiguai Pet Hospital (Tianjin, China). A large amount of ascites was found by abdominocentesis. FCoV was detected by RT-PCR in ascites and the FIP was diagnosed. The symptoms include aphagia, diarrhea, abdominal distension (ascites), lethargy, emaciation and breathing difficulties (Fig.1)
The RT-PCR of ascites indicated a high viral load of FCoV (Ct value 21.73). The laboratory testing results reflected elevated levels of white blood cells (WBC) and neutrophile granulocyte (Neu), indicating severe inflammation of the cat (Table 1). In addition, there were alteration in immune function measures: levels of lymphocyte rate (Lym%) significantly decreased, which indicated that the lymphocytes depletion caused by the virus. Given the cat’s diarrhea and breathing difficulties, the SAA (markers of inflammation and tissue injury) was tested (Fig 2A). The patient received supportive care, including normal saline and protein for nutrition. Given the serve clinical presentation, the veterinarian recommends euthanasia or experimental drug GS-441524 for the cat. In consideration of the high price of the treatment with GS-441524, cat guardians have to seek to other therapies.
The guardian turned to look for help from traditional Chinese medicine. Given the cat’s coronavirus infection and breathing difficulties, the LH capsule was recommended, which has been prescribed in treating disease of respiratory system and endorsed by the National Heath Commission for treatment of covid-19. The FCoV and SARS-CoV-2 share partly RNA sequence identity, therefore, drug targeting viral of SARS-CoV-2 are likely to be effective for FCoV.
On November 17, 2020, the Cat "Big tangerine" was given LH capsule (table 2) three times a day, 4 capsules at a time (0.35 g per capsule) combined with antipyretics, no adverse events were observed. 24 hours later (Nov, 18, day 1), his shortness of breath relieved. He just received liquid food during these times for his continued anorexia and diarrhea. 48 hours after taking medicine (Nov, 19, day 2), the patient’s condition remained largely stable, and his first loose stools was reported; meanwhile his mental state is a bit better. He could sit licking his hair, instead of lying on the ground and panting just like a few days before. 3 days after taking the medicine (Nov, 20th), he was observed to feed himself (though in small amounts). Within the next 7 days of treatment, his appetite improved and ascites gradually decreased. His stools have been loose during this time. At the beginning of December, he was given a palpation examination, which showed the ascites almost completely disappeared. As shown in Fig.1, with the disappearance of ascites, he was estimated to be about 1.5 kg lighter, which was the lightest weight during the whole process. On Dec, 2nd, all symptoms have resolved. He began to run and play with the other cats.
Outcome and Follow-up
The patient continues to take LH capsule medication daily until on Dec.9th. The medication period lasted for 3weeks and the symptoms did not recur after the drug withdrawal. He was taken to Guaiguai Pet Hospital on Jan, 3rd and his blood counts and SAA level lie within the normal range, apart from total protein (8.2g/dL, Normal 5.4-8.2) and blood urea nitrogen (42mg/dL, Normal 10-30). (table 3 & Fig. 2). His specimens later tested negative by FCoV RT-PCR which meant the FCoV viral load was lower than the limit of detection. The symptoms did not recur until the report submission (Mar.17th).