FIP is notoriously hard to diagnose if it is dry form - but even the wet form does have a differential.
Dear all, Today we had to say goodbye to our 11 week old baby Alfie. 3 days ago he started to get sick; his appetite was gone, he was lethargic, I could feel his spine and ribs while his tummy felt "healthy" as if he just had eaten.
All these symptoms worried me, so I went with him to the vet the day after. They took blood samples to send to the lab. The abdominal puncture fluid was clear, colourless and not stringy.
The following day we got back the results from the lab and they were not consistent with fip. Today, we took him to a clinic for an ultrasound, a Rivalta test and an analysis of the puncture fluid. The Rivalta test was very clearly negative and through the ultrasound we learned Alfie had a congenital disorder; his pericardium contained not only his heart but also a big part of his liver... This is not a inherited disease but "just" something in the embryonic development that went wrong :(
Without surgery there was no chance for Alfie, so we didn't have a choice but to give him this chance and left him there for surgery later today. Unfortunately Alfie was already too weak or maybe just too young too cope with the anaesthetics and died even before the surgery could start. Obviously we are very sad about this...
For three days I lived with the sadness, stress and insecurity that a lot of you have been through too when you discover your kitten might have fip. I have been in contact with some of you and I searched the internet for information about fip and differential diagnosis while at the same time I was afraid to believe it could be anything else but the much dreaded fip... It's for this reason that I want to share Alfie's story. If you think your kitten might have (the beginning of) wet fip, insist on all the tests at once. Blood and puncture fluid analysis, Rivalta test and ultrasound of abdomen and thorax, because my Alfie is proof that this can give some of the symptoms presented by fip.
PS On the picture you can see Alfie in better days... We miss him so much :(
Dr Pedersen's comments on expensive diagnostic tests
"Okay, I'm not going to do many graphic pictures, but I do not understand why veterinarians have so much trouble diagnosing it like me, okay. I do not understand it because there are just the two forms. There is the wet form and the dry form and sometimes there is a little intermediate as they can switch from one to another and you can catch them in that transition stage, but people seem to have a hard time making this diagnosis, and like Al said, if you have a young cat from a shelter cattery that has a distended abdomen and has this yellowish, mucinous fluid that contains the right kind of inflammatory cells, high protein… gee, what else is this? What else can we call it? And the problem that we have is that because the diagnosis of FIP as I said, once they become clinically apparent, they’re going to die, okay, and I tell you right now, they’re going to die. There is no treatment. Okay… that I know of, that has been successful to reverse this thing. Okay, so basically because it’s a fatal disease, people especially veterinarians, and especially owners and especially pathologists; do not want to tell you that this is a fatal disease. They say, just as Al says. You get tired of seeing a path report that describes, there's a clinical history just like FIP, lesions that cannot be anything but FIP and then they say, characteristic of FIP, typical FIP. What does that mean? You tell me, does it have FIP? Just tell me.
And so, the problem is that in any of these kinds of diseases where there is a 100% mortality and believe me, owners are just as guilty because owners will push that risk, and is there a chance that it is this, or it is that, toxoplasmosis is one million, you know, is it the mycosis, one in a million, you know, all of these things, and so, they are always grasping for stuff and they are pushing it, and the more they push you, the more diagnostic tests that you ask for, and the problem is that hardly any of those diagnostic tests are 100% correct. And so, even the PCR test maybe only 80%. Immunohistochemistry might be 70-80% depending on what you do. The blood work is not 100%. They are all just little things that help you make the diagnosis, but there is not a single test that’s simple, short of taking a biopsy or taking some fluid, and doing a specific test by a lab that knows what they are doing, which is another problem, okay, to get a decent result back. And then, you know, then there are still veterinarians refusing to believe that antibody titers are not necessarily diagnostic, so they will continue to do the FIP virus serology on a whole bunch of cats. One cat will die of FIP in the cattery. They will test every cat for $30 or $40 a cat, and then they’ll get the results back and then they will say, “Well, I don’t know what they mean.” So then they’ll call me up. Well, I didn’t order 50 serologies at $50 a piece, you know, and so they wanted a free consult, you know, as far as I never charge for consults, but they want a consultation as to what that test means, well, no veterinarian should ever ask for a test that they do not know how to interpret it. If the results come back [Applause] if the results come back and they can’t interpret it, why the hell did they ask for it in the first place?" from WINN feline foundation 2011 FIP symposium