# Perirenal hemorrhage associated with feline infectious peritonitis: a novel presentation of a classic disease

## TL;DR

This study reports a new symptom of feline infectious peritonitis: perirenal hemorrhage, which could help in diagnosing the disease in cats.

## Contribution

The study identifies perirenal hemorrhage as a novel and previously unreported lesion in feline infectious peritonitis.

## Key findings

- Perirenal hemorrhage was observed in five cats with FIP, with additional hemorrhages in other regions in some cases.
- Histologic evidence of FIP was found in the kidneys and retroperitoneal fat of four cases, with FCoV antigen detected in three.
- Perirenal hemorrhage is a unique manifestation of FIP that should be considered in diagnostic evaluations of cats.

## Abstract

Feline infectious peritonitis (FIP), caused by a mutated biotype of feline coronavirus (FCoV; Coronaviridae, Alphacoronavirus), is a significant disease of felids. We investigated perirenal hemorrhage, an unreported lesion in FIP, through a retrospective analysis of 51 immunohistochemistry-confirmed FIP cases submitted to the Diagnostic Services Unit (DSU; University of Calgary, Calgary, Alberta, Canada) between 2010 June 30 and 2024 June 30. Five cats had perirenal hemorrhage in the right retroperitoneal space; 4 had concurrent subcapsular renal hemorrhage; and 1 had sublumbar muscle hemorrhage and hemoabdomen. One case had additional hemorrhages in the brain and cervical spinal cord. Concurrent gross lesions typical of FIP included pyogranulomatous inflammation in various organs and protein-rich cavitary effusions. Histologic lesions typical of FIP (vasculitis and pyogranulomatous inflammation) were present in the kidneys and retroperitoneal fat of 4 cases, and in 3 cases, FCoV antigen was demonstrated in the regions of hemorrhage. The exact mechanism of this hemorrhage is unknown, but we speculate that vasculitis caused by FIP is the cause. Despite the relatively low prevalence of perirenal hemorrhage in this cohort, this lesion represents a unique, previously unreported manifestation of FIP that clinicians and pathologists should be aware of and consider in the differential diagnosis for fluid accumulation or space-occupying lesions in the retroperitoneum of cats.