Whenever I have veterinary students seeing practice with me, I remind them never to forget that "Common things are common" when they are trying to make a diagnosis. Recently, however, I was presented with a challenging case that presented in a way that was anything but common!

"Scratch", a 10 year old cat, had been missing for 2 days, and had returned looking extremely lethargic and poorly. She was virtually collapsed when I first saw her. I rushed her into hospital to run some tests. These showed that she had a very low blood sugar level.

In cats, there are very few things that can cause this, and all are rare. We tested Scratch for rare cancers and hormonal disorders that might explain this, but drew a blank. One of the possibly explanations for low blood sugar was septicaemia - a massive, overwhelming infection. However, Scratch did not have a high temperature, which would usually occur in an infection. In fact, her temperature was lower than normal.

I was at a loss as to what to do next. I x-rayed her chest on the off chance that I would find something abnormal, as Scratch was breathing a little more rapidly than normal, but all looked normal. With Scratch deteriorating and no diagnosis, I did what I endeavour NOT to do on a regular basis - I started to give her antibiotics - just in case it did turn out to be septicaemia. Antibiotics tend to be over-prescribed by vets and doctors alike, and with all the current issues with antibiotic resistance, we have a responsibility to try not to give them unless we feel they are truly justified. However, in Scratch's case, my decision did indeed turn out to be justified, as within 24 hours there was a dramatic improvement. We continued her antibiotics and she went on to make a full recovery, much to the relief of her concerned family.

A few days later, my monthly veterinary research journal fell on my doormat. There was an article in it on a condition called "Systemic Inflammatory Response Syndrome", (SIRS) - a condition that can develop when an animal has septicaemia. As I read it, I realised that it was describing Scratch's case exactly - typical findings of low blood sugar, rapid breathing and often low body temperature (as the cat goes into shock) were described.

As I reminded myself that "common things are common" (that is - infections in cats - often due to a bite from another cat), I also made a mental note to remember that sometimes common problems can present themselves in uncommon ways!

Geraldine Young BVSc CertSAM MRCVS

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