C09995483 / invoice 10000

06/03/2026 Clinician: BMV 

History: 
Presented today for revisit 6 weeks after commencing molnupiravir  for FIP - dry (mid abdominal granuloma), PCR positive. Incomplete response to GS-441524, with worsening of clinical signs and blood parameters at 14w of treatment.  Also tx with marbofloxacin as aspirate cultured positive. 
Theo is eating and drinking normally. Playing normally. Stool occasionally a little soft. He did vomit a few times - cloudy liquid during the month. 

Meds: 
- Molnupiravir 60mg PO BID
- Marbofloxacin 12.5mg PO SID - discontinued
- GS441524 62.5mg PO SID - dose increased 31/12/25. Discontinued 2 weeks ago. 

Exam:
Weight: 4.3kg - previosuly 4.1kg
QAR, BCS 5/9, HR 150, RR 32, T 38.8
MM: pink and moist, CRT < 2 sec
EENT: eyes clear, no discharge, no blepharospasm. Ears clean, no discharge, no malodour. No nasal discharge. 
CV/Resp: heart auscults clear, no murmurs noted. Clear breath sounds in all lung fields, no crackles or wheezes
GI/UG: an abdominal mass is not palpable today.
Integ: clean and shiny haircoat
LN: peripheral lymph nodes palpable < 1cm

Diagnostics:
1) CBC
2) Biochemistry:
3) Recheck ultrasound: mid abdominal mass/LN has reduced in size compared to assessment 4 weeks ago - 1.5x0.59cm, reduced surrounding inflammation. There is very scant peritoneal fluid, less than previously observed. 

Assessment: 
- Feline infectious peritonitis
1) Abdominal mass - neutrophilic to pyogranulomatous lymph node - most suspicious for possible feline infectious peritonitis
2) Non-regenerative anaemia
3) Lymphopaenia - likely stress leukogram
4) Neutrophilia
5) Hyperbilirubinaemia
6) Hypocalcaemia - likely due to hypoalbuminaemia
7) Albumin:Globulin ratio 0.4. TP & globulin normal. Mild hypoalbuminaemia 17
- Diffuse muscularis thickening on ultrasound, consider underlying chronic enteropathy. 

Plan: 
- Recommended trialing hydrolysed diet (R/C hypoallergenic, Hills z/d) in case of underlying chronic enteropathy