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Is this Pemphigus?

Species: Cat
Breed: domestic shorthair
Age: 2-5 years
My cat Loki is a 4 yr old, neutered male. Over the past 2 years he has been getting sores on the pads of his feet (one foot at a time, but it's happened at least once to each foot), sort of between the "fingers". The sores would happen every 3-4 months. My vet had no idea what it was and suggested it was an infected wound or an abscess. We treated with antibiotics each time, and she suggested trying to bring it to a head with epsom soaks before coming in, in future.

Prior to this week, the most recent incident was in September 2012. Loki had a sore foot, and some little black bumps on his chin. The bumps were itchy and he ripped them open and had a horrible infected mouth. I put him in the cone for a day or two, and then we went to the vet. While he was in the cone he also got little "scabs" inside his ears. The vet treated with antibiotics and biopsied the chin.

He said the results say Loki has eosinophilic granuloma complex and that it could be food allergies, but if we can't control it with diet, we'll need to go on oral steroids for life. At this point we switched to Hills z/d (dry) which has decreased how often this is happening, but he has still had one sore foot incident since - which we soaked and kept him in the cone for, and which seemed to go away on it's own. We have also since switched from silica litter to newspaper pellets.

This week, Loki was in the cone again for a scratched ear (cat fight) and has since developed another swollen, weeping sore on his right hind paw and a big, crusty "scab" in his left ear. He's still in the cone. The back paw is a little fevered and he is "flicking" it like it's itchy and it is weeping. He won't really let me have a good look, so I'm not sure what's going on.

I've read a lot about EGC now, and the problem with his feet just doesn't sound typical or look like any of the pictures. The issue with his ears sort of sounds like eosinophilic plaque, but not really.

I am wondering if the chin issue might have caused the biopsy to be positive for EGC, but that the foot issue might be something else.

My two questions are:
1) Does this sound like EGC or should I still be looking for answers?
2) Other than prevention, what should I do WHILE he has these sores? Do they warrant a trip to the vet (VERY STRESSFUL, Loki is a BAD patient) for steroids or will they go away/heal on their own if kept clean?

This is incredibly stressful for both of us and I don't want to over-vet (they've sent me home without any treatment for this before) or under-vet (if I made it worse I would feel so intensely guilty).

I have also emailed pictures. I'm not sure if they'll be helpful as he's none to keen on me touching that sure foot.

Any insight or help you can offer would be GREATLY appreciated.

(from Calgary)

lesion on cat's ear

paw pad lesion on cat

Online vet, Dr. Marie

Dr. Marie replied:

Thanks for your question and for your photos. I have included two of the best ones in your answer above.

You're right that this does not sound exactly typical of eosinophilic granuloma complex. I can't recall seeing ECG on the foot of a cat, but it still is possible.

Whenever an animal has recurring lesions on the feet and also ears the first thing that I think of is an autoimmune condition. The most likely condition that could cause these lesions is pemphigus foliaceous. Pemphigus is usually treated with steroids which usually need to be given long term. This is usually in a tablet form. Steroid creams don't tend to work well.

There are other possibilities but these seem less likely to me than pemphigus. An allergy such as a food allergy could possibly do this, but I haven't seen foot lesions like this with food allergies. It is conceivably possible that ringworm (a fungal infection) could do this but it would be a long shot.

If this were my case I would be wanting to do some more biopsies. It definitely is possible that the chin problem was a separate problem from the feet and ears. I would want to biopsy both the ear and foot lesions. If the biopsy doesn't come back as pemphigus (or another autoimmune condition) then I would test for ringworm.

I hope things are better soon!

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Disclaimer: Although Dr. Marie is a qualified veterinarian, the information found on this site is not meant to replace the advice of your own veterinarian. and Dr. Marie do not accept any responsibility for any loss, damage, injury, death, or disease which may arise from reliance on information contained on this site. Do not use information found on this site for diagnosing or treating your pet. Anything you read here is for information only.

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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

Is an online vet visit just as good as a trip to your veterinarian? No! But, many times, asking an online veterinarian a question can help save you money. While Dr. Marie can't officially diagnose your pet or prescribe medications, she can often advise you on whether a vet visit is necessary. You can also ask Dr. Marie for a second opinion on your pet's condition.