HISTORY

An adult, spayed female domestic cat was referred for chronic stomatitis and ocular disease evaluation. Histopathological diagnose was chronic lymphocytic-plasmacytic stomatitis and was treated with enrofloxacin and methylprednisolone. Seven months after presented anterior uveitis OU, fever and weight loss. A positive toxoplasmosis title was the reason to treat with clindamycin, prednisolone & chloramphenicol-dexamethasone drops OU. Prior referral, deep stromal corneal ulcer OS, mature neutrophilia, monocytosis and hyperglobulinemia were detected. Physical & ophthalmic exam showed hepatomegaly, gingivitis, faucitis, deep stromal ulcers OU and hypertensive panuveitis. CBC, biochemistry & urinalysis showed hyperglycemia, hyperproteinemia with hyperglobulinemia, glucosuria and proteinuria. Diabetes mellitus was diagnosed. The differential included lymphosarcoma, FIP, fungal infection, bartonellosis, ehrlichiosis, leishmaniosis, cholangiohepatitis and reactive hepatopathy. Systemic treatment was enrofloxacin and insulin. Eye topical treatment was oxytetracycline, atropine and dorzolamide. Corneal keratitis OU became melting in two days and perforated in few hours. Bilateral enucleation was done. Serologic FeLV/FIV & ehrlichiosis tests were negative. Leishmaniosis & toxoplasmosis titles were positive. Bone marrow aspiration & PCR were positive. Allopurinol was added to the treatment. Histopathology showed protozoon amastigotes similar to Leishmania in the entire eye's structures confirmed by immunohistochemistry. One month after treatment BW increased glucosuria decreased and the cat improved.

DISCUSSION

 From the small number of feline leishmaniosis cases reported, it is possible that cats are resistant to present clinical signs of leishmaniosis. However in endemic areas, there is a high possibility of being infected. For that reason it is important to include leishmaniosis in the differential diagnosis of immunodeficient cats with systemic diseases and polyclonal gammopathy.

 In endemic areas, leishmaniosis is an important canine uveitis etiology. Cats use to present uveitis as a clinical sign of many infectious systemic diseases and for that reason leishmaniosis should be included in differential diagnosis of Feline Uveitis.

 Feline leishmaniosis treatment is not defined due to the small number of reported cases. The treatment of the predisposing cause and allopurinol seems to be a good therapeutic option.

 To the authors' knowledge this is the second description of panuveitis due to feline leishmaniosis, but it is the first one with associated melting keratitis. It is the first case of ocular and visceral feline leishmaniosis diagnosed "in vivo" and under systemic treatment.

 Type 3 diabetes mellitus is the most probably diabetes type in this case. Progressive decrease in corticosteroid dosage and leishmaniosis control will allow the cat to maintain the glycemia without insulin.