Q: Our cat rescue has a very underweight cat with unstoppable diarrhea. No fever. Fecal sample showed no parasites. He has been treated with Metronidazole, Baytril, Amoxicillan (for loads of white cells in his feces, now gone), Ponazuril, Proviable paste, Fortiflora, & prednisolone. Started on Vitamin B12 injections 2 weeks ago.

Nothing helps.

He eats well, has gained a pound (was only 4 lbs when we found him & 3 years old!). Feces just ooze out of him all the time. Was eating a variety - canned Hills A/D & Royal Canin Recovery & Purina EN. Also Purina EN dry. Am now just giving the canned & dry EN instead of switching back & forth. But nothing is working. He needs his rear end bathed every other day for the slime on his tail & legs & anus. Is VERY sore. What to do?

Yikes!!! That is worrisome.

The fact that he gained weight is positive and probably tells us he has enzymes to digest his food, so  I would start asking these questions:

What is his feline leukemia or FIV status? Any chance of coronavirus or FIP (hopefully not).

Will he respond to whole foods (either commercial or home cooked)? Especially if hypoallergenic ingredients are used?

Would he respond to a trial of Tylosin? It can work when metronidazole does not.

Are we sure he doesnt have tritrichomonas? This will give him a sore behind, just like you describe. And you've got to use Ronidazole (metro won't work).

Is the dose of prednisolone or metronidazole correct for his condition or should it be higher? Were they given for more than 1 round?

It’s a rescue so probably ultrasound is cost prohibitive...but it's still of interest...

Good luck with this little guy. A hair dryer set on low can help dry out their skin if he tolerates it, and some panalog we use sometimes for raw skin.  Wish I could help you more!

Dr. Kris