Xylitol intoxication associated with fulminant hepatic failure in a dog

Objective: To describe a case of xylitol intoxication causing fulminant hepatic failure in a dog. Case summary: A 2.5‐year‐old castrated male English Springer Spaniel weighing 26 kg, was presented after ingestion of half of a loaf of bread containing the sweetener xylitol. Toxic effects of the xylitol in this dog included vomiting, mild hypoglycemia and fulminant hepatic failure. Clinical management of acute hepatic failure and subsequent coagulopathy with supportive care and fresh frozen plasma is described. The dog was discharged 3 days after admission after a full clinical recovery. New or unique information provided: This paper describes the clinical consequence and successful treatment of fulminant hepatic failure in a dog following ingestion of xylitol.     

Clinical and histologic outcome in a dog surviving massive hepatic necrosis

This report describes the clinical and histologic recovery of a 2‐year‐old mixed‐breed dog presented with hypovolemic shock, markedly increased serum alanine amino transferase activity, and hemoabdomen. Emergency exploratory surgery revealed a friable liver with multiple capsule hemorrhages necessitating removal of the left lateral lobe. Histologic evaluation showed acute massive hepatic necrosis with centrilobular and midzonal distribution. The dog survived, and all monitored laboratory values normalized within 7 weeks. A liver biopsy taken 8 weeks after presentation revealed normal hepatic architecture with a few, randomly distributed neutrophilic foci. Follow‐up included intermittent determination of liver variables including liver function tests for a period of 7 years. The dog's health status, and all test results remained normal during this time. Complete recovery and good long‐term quality of life after life‐threatening acute liver failure secondary to massive hepatic necrosis is possible in dogs.     

Concurrent renal amyloidosis and thymoma resulting in a fatal ventricular thrombus in a dog

Thymoma‐associated nephropathies have been reported in people but not in dogs. In this report, we describe a dog with thymoma and concurrent renal amyloidosis. A 7‐year‐old castrated male Weimaraner was presented for progressive anorexia, lethargy, and tachypnea. The dog was diagnosed with azotemia, marked proteinuria, and a thymoma that was surgically removed. Postoperatively, the dog developed a large left ventricular thrombus and was euthanized. Necropsy confirmed the presence of a left ventricular thrombus and histopathology revealed renal amyloidosis. We speculate that the renal amyloidosis occurred secondary to the thymoma, with amyloidosis in turn leading to nephrotic syndrome, hypercoagulability, and ventricular thrombosis. This case illustrates the potential for thymoma‐associated nephropathies to occur in dogs and that dogs suspected to have thymoma should have a urinalysis and urine protein creatinine ratio performed as part of the pre‐surgical database.     

Trauma‐associated acute mesenteric ischemia in a dog

Objective – To describe the successful management of acute mesenteric ischemia (AMI) in a dog. Case Summary – An 11‐year‐old, 21.4 kg, male castrated Rough‐Coated Collie was referred for evaluation of an acute abdomen following sustaining injuries in a vehicular accident. On presentation to the hospital, clinicopathologic assessments were within normal limits and distended intestinal loops were evident on abdominal palpation. Plain and contrast radiography demonstrated diffusely distended gas‐filled intestinal loops with a delayed barium transit time. Emergency surgical exploration was performed. The cecum and the proximal two‐thirds of the colon were dark purple to black in color and there were no palpable pulses in the mesenteric arteries associated with the cecum and colon. The cecum and proximal two‐thirds of the colon were resected and an ileocolic anastomosis was performed. The dog recovered well from surgery and was discharged 2 days later. Histopathologic examination was consistent with AMI. New or Unique Information Provided – AMI is uncommonly reported in human medicine and is a rare complication from even minor blunt abdominal trauma. This is the first reported case of trauma‐associated AMI in a dog.     

IMAGING DIAGNOSIS—ECTOPIC SPLEEN MIMICKING HEPATIC TUMOR WITH INTRA‐ABDOMINAL METASTASES INVESTIGATED VIA TRIPLE‐PHASE HELICAL COMPUTED TOMOGRAPHY IN A DOG

A 10‐year‐old castrated male miniature dachshund was presented with an abdominal mass. The dog had a history of splenectomy. Triple‐phase helical computed tomography was utilized, revealing a hepatic mass and multiple intra‐abdominal solid masses. In triple‐phase helical computed tomography the images, hepatic mass and two of four intra‐abdominal masses were heterogenous in all phases. Therefore, we diagnosed a malignant hepatic tumor and presumed intra‐abdominal metastases. The masses were surgically removed and were histologically composed of normal spleen tissues, findings which were consistent with ectopic spleen.     

Pituitary Macrotumor Causing Narcolepsy‐Cataplexy in a Dachshund

Familial narcolepsy secondary to breed‐specific mutations in the hypocretin receptor 2 gene and sporadic narcolepsy associated with hypocretin ligand deficiencies occur in dogs. In this report, a pituitary mass is described as a unique cause of narcolepsy‐cataplexy in a dog. A 6‐year‐old male neutered Dachshund had presented for acute onset of feeding‐induced cataplexy and was found to have a pituitary macrotumor on magnetic resonance imaging (MRI). Cerebral spinal fluid hypocretin‐1 levels were normal, indicating that tumor effect on the ventral lateral nucleus of the hypothalamus was not the cause of the dog's narcolepsy‐cataplexy. The dog was also negative for the hypocretin receptor 2 gene mutation associated with narcolepsy in Dachshunds, ruling out familial narcolepsy. The Dachshund underwent stereotactic radiotherapy (SRT), which resulted in reduction in the mass and coincident resolution of the cataplectic attacks. Nine months after SRT, the dog developed clinical hyperadrenocorticism, which was successfully managed with trilostane. These findings suggest that disruptions in downstream signaling of hypocretin secondary to an intracranial mass effect might result in narcolepsy‐cataplexy in dogs and that brain MRI should be strongly considered in sporadic cases of narcolepsy‐cataplexy.     

Bronchial stent placement in a dog with bronchomalacia and left atrial enlargement

A 13‐year‐old neutered male Maltese was referred for paroxysms of coughing and cyanosis, with radiographic evidence of bronchial disease and cardiomegaly. Investigation with echocardiography, bronchoscopy, fluoroscopy and bronchoalveolar lavage led to a diagnosis of myxomatous mitral valve degeneration with insufficiency, ISACHC class II heart failure and bronchomalacia with severe left mainstem bronchial collapse. Persistence of intractable cough despite medical therapy prompted placement of a stent in the left mainstem bronchus. Immediately after stent placement, severe pulmonary oedema developed, thought to be due to compression of the left atrium by the stent or acute lung injury related to stent placement. The dog recovered over a 3‐day period with diuretic therapy and positive end expiratory pressure ventilation. Subsequently, the dog died from congestive heart failure 102 days after stent placement, during which time occasional, self limiting coughing episodes occurred .     

Green discolouration of urine following propofol infusion in a dog

A three‐year‐old, female neutered Weimaraner was presented with a history of neck pain and tetraparesis. MRI revealed an extradural mass at the level of C3 vertebra, which was thought to be a spinal abscess, and the dog was scheduled for surgical exploration the following morning. Overnight the dog developed an exaggerated ventilatory pattern, with paradoxical inward movement of the thorax on inspiration. Arterial blood gas analysis revealed respiratory acidosis and ventilator support was initiated to prevent excessive respiratory fatigue. During mechanical ventilation, anaesthesia was maintained using a propofol target‐controlled infusion system and, subsequently, the dog produced bright green urine in the urine collection system. Although previously documented in humans, this appears to be the first report of green urine in a dog following propofol use.     

Presumptive Iatrogenic Microcystin‐Associated Liver Failure and Encephalopathy in a Holsteiner Gelding

An 8‐year‐old Holsteiner gelding was presented for evaluation of anorexia, obtundation, icterus, and mild colic signs of 48 hours duration. History, physical examination, and initial diagnostics were suggestive of hepatic disease and encephalopathy. Microcystin toxicosis was suspected based on historical administration of a cyanobacteria supplement, associated serum biochemistry abnormalities, and characteristic histopathological changes. Microcystin contamination was confirmed in both supplement containers fed to the horse. Fulminant hepatic failure and encephalopathy progressed resulting in euthanasia. Necropsy findings were consistent with microcystin induced liver failure.     

C‐reactive protein concentration in dogs with primary immune‐mediated hemolytic anemia

Background: Canine primary immune-mediated hemolytic anemia (IMHA) is associated with a high-mortality rate. C-reactive protein (CRP) is the most important acute-phase protein in dogs and may have value as a marker of prognosis or response to treatment in IMHA. Objective: The objectives of this study were to evaluate serum CRP concentration in dogs with primary IMHA at presentation and during treatment, to assess potential differences based on survival time, and to compare CRP with other laboratory parameters of inflammation and prognosis. Methods: Inclusion criteria for primary IMHA were anemia (PCV<0.30 L/L), a positive Coombs' test or persistent autoagglutination of erythrocytes, and the exclusion of underlying diseases by other diagnostic tests. Dogs were divided into 2 groups based on survival: dogs that were still alive 14 days after start of treatment (group 1) and dogs that died or were euthanized before day 14 (group 2). Serum CRP concentration, a CBC, and a biochemistry profile were performed on days 0, 3, 8, and 14. Serum CRP also was determined in 25 clinically healthy dogs. Results: CRP concentration in the 25 clinically healthy dogs ranged from 0–8.9 μg/mL (median 2.2 μg/mL). Thirty dogs were diagnosed with primary IMHA, 24 in group 1 and 6 in group 2. On day 0, CRP concentration in dogs in both groups (median 224 μg/mL) was increased above the reference interval. In group 1 dogs, median CRP concentration was 242 μg/mL on day 0, 69 μg/mL on day 3, 35 μg/mL on day 8, and 2 μg/mL on day 14. In group 2 dogs, median CRP concentration was 194 μg/mL on day 0, 119 μg/mL on day 3, and 41 μg/mL on day 8; only 1 dog in group 2 survived to day 8. There was a significant correlation between CRP and total WBC concentrations on days 0 and 3 (r=−.598, P=.003). Conclusions: Serum CRP concentration was markedly increased in dogs with primary IMHA. CRP concentration did not differ based on patient survival, but might be a marker for long-term monitoring of these patients.     

A Cross‐Sectional Study Examining the Prevalence and Risk Factors for Anti‐Microbial‐Resistant Generic Escherichia coli in Domestic Dogs that Frequent Dog Parks in Three Cities in South‐Western Ontario,Canada

Anti‐microbial resistance can threaten health by limiting treatment options and increasing the risk of hospitalization and severity of infection. Companion animals can shed anti‐microbial‐resistant bacteria that may result in the exposure of other dogs and humans to anti‐microbial‐resistant genes. The prevalence of anti‐microbial‐resistant generic Escherichia coli in the faeces of dogs that visited dog parks in south‐western Ontario was examined and risk factors for shedding anti‐microbial‐resistant generic E. coli identified. From May to August 2009, canine faecal samples were collected at ten dog parks in three cities in south‐western Ontario, Canada. Owners completed a questionnaire related to pet characteristics and management factors including recent treatment with antibiotics. Faecal samples were collected from 251 dogs, and 189 surveys were completed. Generic E. coli was isolated from 237 of the faecal samples, and up to three isolates per sample were tested for anti‐microbial susceptibility. Eighty‐nine percent of isolates were pan‐susceptible; 82.3% of dogs shed isolates that were pan‐susceptible. Multiclass resistance was detected in 7.2% of the isolates from 10.1% of the dogs. Based on multilevel multivariable logistic regression, a risk factor for the shedding of generic E. coli resistant to ampicillin was attending dog day care. Risk factors for the shedding of E. coli resistant to at least one anti‐microbial included attending dog day care and being a large mixed breed dog, whereas consumption of commercial dry and home cooked diets was protective factor. In a multilevel multivariable model for the shedding of multiclass‐resistant E. coli, exposure to compost and being a large mixed breed dog were risk factors, while consumption of a commercial dry diet was a sparing factor. Pet dogs are a potential reservoir of anti‐microbial‐resistant generic E. coli; some dog characteristics and management factors are associated with the prevalence of anti‐microbial‐resistant generic E. coli in dogs.     

IMAGING DIAGNOSIS—A CASE OF SPONTANEOUS HEPATIC PORTAL VEIN GAS IN AN 11‐MONTH‐OLD WEST HIGHLAND WHITE TERRIER

An 11‐month‐old female entire West Highland White Terrier presented for chronic diarrhea with acute deterioration in demeanor and progression to systemic inflammatory response syndrome. Transcutaneous abdominal ultrasonography identified colonic ulceration and secondary mucosal gas. Suspected hepatic portal vein gas and hepatic parenchyma gas were also visualized. The patient was stabilized and managed for ulcerative colitis. Based on endoscopic biopsies, the dog was diagnosed with severe, chronic, pyogranulomatous colitis. On repeat ultrasonographic evaluation the portal vein and hepatic gas had resolved but the patient deteriorated and was ultimately euthanized due to sepsis.     

X‐linked CD40 ligand deficiency in a 1‐year‐old male Shih Tzu with secondary Pneumocystis pneumonia

An approximately 1‐year‐old male intact Shih Tzu dog was referred to a tertiary facility with a history of progressive tachypnea, increased respiratory effort, and weight loss over a 3‐month period that failed to improve with empirical antimicrobial treatment. Upon completion of a comprehensive respiratory evaluation, the dog was diagnosed with severe Pneumocystis pneumonia and secondary pulmonary hypertension. Clinical signs resolved and disease resolution was confirmed after completion of an 8‐week course of trimethoprim‐sulfonamide, 4‐week tapering dose of prednisone to decrease an inflammatory response secondary to acute die‐off of organisms, a 2‐week course of clopidogrel to prevent clot formation, and a 2‐week course of a phosphodiesterase‐5 inhibitor to treat pulmonary hypertension. Immunodiagnostic testing and genetic sequencing were performed to evaluate for potential immunodeficiency as an underlying cause for the development Pneumocystis pneumonia, and identified an X‐linked CD40 ligand deficiency.     

IMAGING DIAGNOSIS ‐ SPONTANEOUS SUBPERIOSTEAL VERTEBRAL HEMORRHAGE IN A GREYHOUND

A 4‐year‐old, spayed female greyhound dog was presented with an acute onset of paraplegia. There was no known history of trauma or coagulopathy. Spinal cord compression was identified on MRI. Intra‐operative evaluation revealed the presence of a large subperiosteal hematoma and a smaller epidural hematoma. To the authors’ knowledge, this is the first report of a spinal subperiosteal hematoma diagnosed antemortem through MRI, with surgical exploration and successful treatment in a dog.     

ACVIM consensus statement on the treatment of immune‐mediated hemolytic anemia in dogs

Immune‐mediated hemolytic anemia (IMHA) causes severe anemia in dogs and is associated with considerable morbidity and mortality. Treatment with various immunosuppressive and antithrombotic drugs has been described anecdotally and in previous studies, but little consensus exists among veterinarians as to the optimal regimen to employ and maintain after diagnosis of the disease. To address this inconsistency and provide evidence‐based guidelines for treatment of IMHA in dogs, we identified and extracted data from studies published in the veterinary literature. We developed a novel tool for evaluation of evidence quality, using it to assess study design, diagnostic criteria, explanation of treatment regimens, and validity of statistical methods. In combination with our clinical experience and comparable guidelines for humans afflicted with autoimmune hemolytic anemia, we used the conclusions of this process to make a set of clinical recommendations regarding treatment of IMHA in dogs, which we refined subsequently by conducting several iterations of Delphi review. Additionally, we considered emerging treatments for IMHA in dogs and highlighted areas deserving of future research. Comments were solicited from several professional bodies to maximize clinical applicability before the recommendations were submitted for publication. The resulting document is intended to provide clinical guidelines for management of IMHA in dogs. These guidelines should be implemented pragmatically, with consideration of animal, owner, and veterinary factors that may vary among cases.     

Interference of an algal nutritional supplement with a urinary metabolic screening test for glycosaminoglycans in a dog suspected to have a storage disease

The finding of excess urinary glycosaminoglycans (GAG) is the first step in the laboratory diagnosis of mucopolysaccharidosis (MPS). Urinary screening tests are based upon the binding of GAG to dimethylmethylene blue. Alternatively, paper spot tests using toluidine blue are used in human and veterinary laboratory medicine. Positive samples undergo GAG isolation for subsequent characterization. Here, we describe a 3‐year‐old English Cocker Spaniel with a positive urinary GAG test, but without other clinical signs of MPS. Urine samples were strongly positive with the dimethylmethylene blue test, and isolated GAG subjected to electrophoresis on cellulose acetate revealed a band co‐migrating with dermatan sulfate. However, the isolated GAG were resistant to digestion with chondroitinase ABC, suggesting that the band did not represent dermatan sulfate. This was confirmed by mobility of the isolated GAG different from dermatan sulfate on agarose gel electrophoresis. MPS types VI and VII were excluded by enzyme assay. To test the hypothesis of a nutritional source, a healthy control dog was fed the same dog food as the index case. His urine showed a comparable abnormal GAG screening test and electrophoretic pattern. In addition, the analysis of an algal supplement present in the administered dog food showed a similar electrophoretic GAG pattern. The Cocker Spaniel was not available for further testing after withdrawal of the supplement. Algae contain highly sulfated fucans and galactans, and it appears that commercial dog food containing such algal, and possibly other, supplements can give rise to false‐positive urinary MPS screening tests.     

Immune‐mediated hemolytic anemia and severe thrombocytopenia in dogs: 12 cases (2001–2008)

Objective – To identify and characterize the syndrome of immune‐mediated hemolytic anemia (IMHA) with concurrent severe thrombocytopenia (≤15.0 × 10⁹ platelets/L; [15.0 × 10³ platelets/μL]), and to evaluate prognostic factors, clinicopathologic findings, complications, treatment, outcome, and survival of dogs with this hematologic disorder. Design – Retrospective, observational study. Setting – Veterinary teaching hospital. Animals – Twelve client‐owned dogs with IMHA and severe thrombocytopenia (≤15.0 × 10⁹ platelets/L; [15.0 × 10³ platelets/μL]), without evidence of overt disseminated intravascular coagulation. Interventions – The following data were recorded and analyzed from the electronic medical record: signalment, history, concurrent diseases, clinical signs at presentation, clinicopathologic data, diagnostic testing, radiographic findings, treatment modalities, length of hospitalization, complications, and clinical outcome. All dogs were treated with immunosuppressive doses of corticosteroids. Measurements and Main Results – Twelve dogs were identified with the diagnosis of IMHA and severe thrombocytopenia; of these, 9 (75%) survived, 3 (25%) were euthanized, and none died. Dogs that survived were significantly younger than nonsurvivors (P=0.03). There were no specific clinical signs or therapies associated with survival. Conclusions – Dogs in this study had a mortality rate similar to reported rates for dogs with either disease alone. Overall, younger dogs were more likely to survive. No association between different treatment modalities and overall survival was identified.     

Toxic effects of cyclonite (C‐4) plastic explosive ingestion in a dog

Objective – To describe the clinical manifestations following cyclonite (C‐4) plastic explosive ingestion in a dog. Case Summary – A 2‐year‐old male castrated Labrador working dog weighing 35 kg was presented for seizures shortly after ingestion of C‐4. The dog was successfully treated for the seizures, but developed polyuria/polydipsia shortly after being discharged and was ultimately diagnosed with chronic kidney disease. New or Unique Information Provided – This is the first documented case of renal insufficiency in a dog after C‐4 intoxication.     

Management of femoral artery thrombosis in an immature dog

Objective: To report a case of femoral artery thrombosis and its medical management in a young dog. Case summary: A 13‐week‐old, female Boxer puppy presented with hind limb paralysis after an abdominal crush injury. A left femoral artery thrombus was identified on ultrasound. No spinal trauma was visualized in imaging studies. Clinical management of arterial thrombosis in a 13‐week‐old puppy with streptokinase and dalteparin therapy is described. New or unique information provided: This paper describes an unusual presentation of arterial thrombosis. The medical management with streptokinase and dalteparin is also out of the ordinary. Images that document the development of compensatory circulation around the thrombosed vessel are included. Additionally, this paper also documents the altered development that occurred in this immature dog after the thrombotic event.     

Splenectomy as an adjunctive treatment for dogs with immune-mediated hemolytic anemia: ten cases (2003–2006)

Objective – To describe the patient population, disease severity, and outcome in dogs with immune-mediated hemolytic anemia (IMHA) that underwent splenectomy. To compare presurgical and postsurgical data.
Design – Retrospective case series.
Setting – Emergency clinic/referral hospital.
Animals – Ten dogs diagnosed with IMHA.
Interventions – Splenectomy in addition to standard medical management for IMHA.
Measurements – Medical records of 10 dogs with IMHA, in which a splenectomy was performed were reviewed. The population was analyzed with regards to physical and clinicopathologic data, severity, treatment, and outcome. Outcome was defined as survival at 30 days, percentage of dogs on medications at 30 days, and number of relapses documented by 30 days. The presurgical and postsurgical PCV and transfusion requirements were documented and compared for each dog.
Results – Nine of 10 dogs survived to 30 days. Four of the 9 that survived were not on any immunosuppressive medications. There were no relapses during the 30 days. The 3-day postsplenectomy PCVs were significantly higher than presplenectomy. The number of transfusions administered postsplenectomy was significantly less than those administered presplenectomy.
Conclusion – The use of splenectomy may be associated with an improved outcome in dogs with IMHA.