stranguria, and hematuria. The previous history included a urinary tract infection 2 months prior, diagnosed via bacterial culture (Escherichia coli, 50-100 × 10 3 CFU/mL) that was susceptible to amoxicillin-clavulanic acid (Clavamox; Zoetis), which was prescribed (12.5 mg/kg BID for 30 days) with no improvement. On presentation, the patient had a thin body condition (3/9) with no other abnormal findings. An abdominal ultrasound revealed marked thickening of the urinary bladder wall with multiple nodular masses, bilateral hydroureter (left worse than the right), and severe left hydronephrosis. Cystocentesis was performed, and the urine was grossly red-brown and turbid with a urine specific gravity of 1.016. The pH was 7.5 with moderate proteinuria, 50+ RBCs/hpf, 0-2 WBCs/hpf, and 5-9 epithelial cells/ hpf. Cytocentrifuge preparations of the urine were air-dried, fixed, and stained using a modified Wright stain (Hematek 3000; Siemens Medical Solutions USA, Inc.) (Figures 1 and 2).
A six‐year‐old, castrated male domestic shorthair cat was presented for a week‐long history of lethargy, acute anorexia, and adipsia. On presentation, the cat was weak with pale mucous membranes, open‐mouth breathing, and mild popliteal lymphadenomegaly. Routine bloodwork revealed bicytopenia due to marked non‐regenerative anemia and moderate thrombocytopenia; erythrocyte clumping was apparent on the blood smear, but no agglutination was noted on a saline dispersion test. Abdominal and thoracic imaging showed marked splenomegaly and multiple mildly enlarged lymph nodes. Aspirates from the bone marrow and spleen contained many erythrophagocytic macrophages and occasional lymphocytes containing engulfed erythrocytes. The macrophages also occasionally contained phagocytosed erythroid precursors, platelets, and leukocytes. A diagnosis of hemophagocytic syndrome was made based on the presence of bicytopenia and increased numbers of hemophagocytic macrophages in the spleen and bone marrow. Though no organisms were observed, Mycoplasma spp. infection was suspected and confirmed via PCR. To the authors' knowledge, this is the first report of a hemophagocytic syndrome in a cat with Mycoplasma haemofelis. Lymphocyte engulfment of erythrocytes has been previously reported in a cat with M. haemofelis infection. Both hemophagocytic syndrome and engulfment of erythrocytes by lymphocytes should prompt testing for Mycoplasma spp. even with a lack of evident parasitemia.
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