Cutaneous vasculopathy and pulmonary thromboembolism in an unstable diabetic cat

A six-year-old, male-neutered, domestic short-haired cat was referred for further management of a three-month history of uncontrolled diabetes mellitus. The cat visited the hospital on three occasions during a three-week time period. Hyperglycemia was documented at all visits.
The cat initially presented with evidence of hypovolemia, cranial abdominal pain and dehydration. Moderate hyperglycemia, mild ketonemia and severe hypokalemia were documented. A 3 x 2 cm skin lesion with associated alopecia and erythema was first noticed at a routine follow-up examination (visit two) one week later. A diagnosis of diabetic ketoacidosis was made six days later. The previously identified skin lesion now measured 6 x 2.5 cm. Two episodes of respiratory distress were identified at this visit, with no evidence of cardiac or pulmonary pathology. The cat developed a moderate anemia (packed cell volume 16 %, total solids 7.9 g/dL) on the fifth day of hospitalization. Fluid therapy, electrolyte supplementation, regular insulin, anti-emetic and analgesia medications were administered during visits one and three. Due to development of anemia, suspected pulmonary thromboembolism events and progression of skin lesions, euthanasia was elected. A diagnosis of cutaneous vasculopathy with secondary ischemic necrosis was made post-mortem and pulmonary thromboembolism was confirmed.
To the authors’ knowledge, this is the first report of cutaneous vasculopathy and pulmonary
thromboembolism in a cat with confirmed diabetes mellitus, warranting further research to
assess if hypercoagulability is common in this patient population, as routine thromboprophylaxis and anti-coagulation may be potentially indicated.