EXPRESS: Administration of porcine surfactant in the treatment of a fatal case of Acute Respiratory Distress Syndrome in a cat with calicivirus pneumonia

Case Summary A one-year-old male neutered Persian cat presented to the emergency room with acute, severe wheezing and coughing following the introduction of a new kitten to the household. The patient progressed to hypoxemic respiratory failure consistent with Acute Respiratory Distress Syndrome (ARDS) and required mechanical ventilation. Real-Time PCR testing from a conjunctival and deep pharyngeal swab confirmed Feline Calicivirus (FCV) infection. Due to refractory hypoxemia and declining lung compliance (2.4 mL/cmH2O), novel therapy with intratracheal porcine surfactant (Curosurf®) was attempted. A dose of 1.5 mL/kg was administered over 60 seconds. Following administration, pulmonary compliance improved to 3.1mL/cmH2O. The patient was weaned from the ventilator on day 10 however, severe laryngeal swelling necessitated the patient to require a temporary tracheostomy. The patient died on day 15 due to tracheal stenosis and obstruction of the stoma site by granulation tissue. Relevance and Novel Information To the authors' knowledge, this is the first report describing the development of ARDS from calicivirus pneumonia and the use of porcine surfactant in the treatment of ARDS in a cat. The administration of surfactant resulted in objective improvements in lung compliance.