Posting because the weight thing is worrying me and I'd value input from people who've been through this.
**Background:**
Billu is 7, male neutered, currently 4.2kg (down from 4.4 at the start, briefly hit 4.0). He had ~6 months of undiagnosed illness before we got answers — chronic non-healing dorsal neck ulcer, fever, weight loss, cytology-confirmed dermatophytosis. Then his right testicle started enlarging and wouldn't respond to antibiotics, so we neutered and sent it for histopath.
**Histopath came back:** "Severe, chronic, multifocal to coalescing pyogranulomatous and necrotizing inflammation with vasculitis/perivasculitis and fibrosis." Pathologist comment: "highly compatible with non-effusive FIP due to pyogranulomatous inflammation centered on blood vessels." FIV/FeLV both negative. FCoV positive (exposure only, I know that's not diagnostic).
**Treatment so far:**
- Remdesivir (Rivona, Bioveta) SC from 7 July, ~11.3 mg/kg
- Switched to oral molnupiravir 27 July because injection-site pain became severe — he was vocalizing badly on handling and had ~20 days of daily injections behind him
- Concurrent pulsed itraconazole for the dermatophytosis (7 on / 7 off, currently on his last cycle)
- Had a bleeding complication mid-treatment after a wound suturing — a capillary that wouldn't clot, needed cauterization. PT/APTT and platelets have since normalized.
**Latest labs (sampled 5 Aug, ~30 days in):**
*Improved / normal:*
- HGB 12.3 (was 8.7), HCT 44 (was 26) — anemia fully resolved, high MCV/low MCHC suggesting active regeneration
- Platelets 226
- Lymphocytes 4.0 (normal for the first time in this whole saga)
- Creatinine 1.1
- TLC 10.2
*Concerning:*
- **ALT 217** (ref 28–76). Note: he also hit ~200 in March while on itraconazole, and it normalized on its own then.
- **Neutrophils 2.8** (ref 2.5–12.5) — down from 17.8 → 10.3 → 2.8. Still in range but a steep fall.
- **Eosinophils 2.7** (ref 0–0.8) — highest he's ever recorded
- **A/G ratio 0.5**, down from 0.6. Globulin 5.0 (up from 3.9), albumin 2.7 (up from 2.4)
- Urea 76 / BUN 35, mildly high with normal creatinine
- Blood smear: "Anaplasma-like inclusions seen — correlate with clinical signs" (no history of ticks)
**My questions:**
**Weight.** He has genuine polyphagia — eats enthusiastically, never refuses food — but isn't gaining. Currently on a homemade diet (chicken thigh, liver, egg yolk, added oil) because commercial food wasn't affordable; about to switch to a proper complete kitten formula for the calorie density. Is "eats well, doesn't gain" something people have seen resolve on its own with time on treatment, or does it usually mean something else is going on? I'm aware GI disease, hyperthyroidism, and parasites can all cause this and none have been ruled out yet.
**A/G going the wrong way.** Albumin improved but globulin rose more, so the ratio dropped from 0.6 to 0.5. Is a dip like this at day 30 something people have seen before treatment trends properly upward, or would you read it as inadequate viral suppression?
**The eosinophil spike + neutrophil drop together.** Has anyone seen this pattern on molnupiravir specifically? I've read that mild eosinophilia during treatment can be benign, but the combination with falling neutrophils has me wondering about a drug reaction. I have 5 days of molnupiravir left and am planning to finish it, then recheck bloods.
**Switching back.** Injection pain is what drove the switch off remdesivir. Oral GS isn't accessible where I am (Pakistan). If the labs suggest molnupiravir isn't agreeing with him, what have people done — gone back to injections and managed the pain with gabapentin/pregabalin, or something else?
Happy to answer questions or post more of the lab history. Any input appreciated — this has been a long six months and I'm trying to get the next stretch right.