Citation: Assawarachan, S.N.; Yodsheewan, R.; Maneesaay, P.; Rattanapinyopituk, K.; Chuchalermporn, P.; Kongchun, A.; Hakhen, B.; Sattasathuchana, P. Feline Cyst-like Lymphocytic Cholangiohepatitis in a Cat: First Case Report. Animals 2022, 12, 3278. https://doi.org/10.3390/ ani12233278 Academic Editor: Mandy Paterson Received: 10 October 2022 Accepted: 22 November 2022 Published: 24 November 2022 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). animals Case Report Feline Cyst-like Lymphocytic Cholangiohepatitis in a Cat: First Case Report Sathidpak Nantasanti Assawarachan 1,2 , Rungrueang Yodsheewan 3 , Phudit Maneesaay 3 , Kasem Rattanapinyopituk 4 , Piyathip Chuchalermporn 2 , Atijit Kongchun 2 , Benjang Hakhen 2 and Panpicha Sattasathuchana 1, * 1 Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Kasetsart University, 50 Ngamwongwan rd., Lat Yao, Jatujak, Bangkok 10900, Thailand 2 Faculty of Veterinary Medicine, Kasetsart University Veterinary Teaching Hospital, Kasetsart University, 50 Ngamwongwan rd., Lat Yao, Jatujak, Bangkok 10900, Thailand 3 Department of Pathology, Faculty of Veterinary Medicine, Kasetsart University, 50 Ngamwongwan rd., Lat Yao, Jatujak, Bangkok 10900, Thailand 4 Department of Pathology, Faculty of Veterinary Science, Chulalongkorn University, 39 Henri Dunant rd., Pathumwan, Bangkok 10330, Thailand * Correspondence: fvetpcs@ku.ac.th Simple Summary: Cholangitis/cholangiohepatitis is the most common inflammatory disease of the biliary system in cats. A tissue biopsy is crucial for a definitive diagnosis. Lymphocytic cholangitis is one type of cholangitis and is identified through histological findings. Treatment requires a long-term immunosuppressive drug. This article is the first report of multiple cyst-like hepatic lesions with histological findings of lymphocyte infiltration in a cat’s liver. Abstract: A 5-year-old female neutered domestic short-haired cat presented with abdominal en- largement. An abdominal ultrasound revealed that large multiple hepatic cysts with irregular walls, hypoechoic fluid, and internal septations occupied most of the liver parenchyma. Serum liver en- zymes, bilirubin, and bile acids concentrations were within normal limits. A fecal examination using simple floatation and formalin-ether sedimentation techniques was negative for liver fluke (Platynosomum fastosum), intestinal protozoa, and other helminth eggs. Praziquantel was prescribed for two distinct courses one month apart without obvious improvement of the hepatic cysts. An abdominal laparotomy and histopathological examination finally enabled diagnosis of cyst-like lym- phocytic cholangiohepatitis of the liver tissue. Twelve weeks of oral prednisolone resulted in marked ultrasonographic improvement of the hepatic cysts. The liver parenchyma was heterogeneous and filled with multiple small anechoic cavities. Twenty-three months after ceasing the prednisolone, there was no recurrence of hepatic cysts. Keywords: cat; cyst; cholangitis; cholangiohepatitis; liver 1. Introduction Feline cholangitis/cholangiohepatitis is an inflammatory condition of two conjunctive organs: the gall bladder and the liver [1,2]. The prevalence of feline cholangitis ranges from 25% to 50% across the world [2–6]. According to the World Small Animal Veteri- nary Association Standardization Committee, there are four forms of feline cholangitis— neutrophilic cholangitis, lymphocytic cholangitis, destructive cholangitis, and chronic cholangitis—associated with liver fluke infestation [7]. Differentiation of the four distinct forms requires a tissue biopsy [7]. Lymphocytic cholangitis is characterized by the presence of an aggregation of lymphocytes around the bile ducts. Cholangiohepatitis occurs when the inflammation extends to the hepatic parenchyma [7]. Cats with lymphocytic cholan- gitis/cholangiohepatitis commonly present with weakness, anorexia, nausea, vomiting, Animals 2022, 12, 3278. https://doi.org/10.3390/ani12233278 https://www.mdpi.com/journal/animals