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Background: Successful medical management of a serious form of Cystic Endometrial Hyperplasia-Pyometra (CEH-P) in a white tiger, with a combination of mifepristone, misoprostol, cloprostenol, cabergoline and enrofloxacin is discussed.Methods: A 14-year-old white tiger (Panthera tigris) belonging to the Zoological Garden, Thiruvanathapuram showed symptoms of gradual discomfort, dyspepsia and polydipsia for two weeks. There were no signs of oestrus for the previous two months and a serosanguinous vaginal discharge was also noticed. On ultrasonographic examination, uterine sacculations filled with fluid could be found which was suggestive of pyometra. Leukocytosis, neutrophilia, increased level of serum progesterone, anaemia, high ESR, persistent hyperproteinaemia and hyperglobulinaemia were evident on haematological examination. Considering the risks associated with performing OHE in large felids, medical management was planned. A combination of mifepristone, misoprostol, cloprostenol, cabergoline, enrofloxacin and supportive therapy were given along with strict and close monitoring by different experts on site or by utilizing telemedicine communication technologies. Periodic hematological examination, serum biochemistry, progesterone estimation and ultrasonographic evaluation were done to evaluate the progress of treatment. The progesterone values during the period of study ranged from 45.6 ng/ml at the commencement of treatment to a basal level of 0.73 ng/ml towards the end of treatment. Result: The animal had an uneventful clinical recovery. Considering the risks associated with performing OHE in large felids, medical management can be considered as a valuable option in treating CEH-Pyometra in wild felids. This being the first report of successful medical treatment of CEH-P in a large captive felid with a combination of antiprogestins, prolactin antagonists, prostaglandins and antibiotics, it is suggested that due consideration of such a treatment regimen is of great importance in large felids.

A Novel Protocol for Medical Management of Cystic Endometrial Hyperplasia-Pyometra in White Tiger