| Monday, September 20, 2010
| Case 20
A 2.5 year old female spayed DSH outdoor was presented to the AcaseAweek Clinic with a five week history of lethargy, has not been eating for the past 2 days, and has many areas of alopecia accompanied by pruritis. She is not up to date on vaccines nor is she on heartworm preventative. She was given pyrantel 3 days ago.
Physical Exam:Weight = 2.2kg
Temp = 101.5
HR/Pulse = 204
RR = 36
General appearance: “scruffy” and unkempt
MM: pale but moist
Oral: Halitosis and stomatitis
CV: Tachycardia but strong pulse
Integument: Areas of alopecia on right lateral stifle, along dorsal spine, left abdomen, dorsal neck with associated areas of scabbing and pustules. Entire head had short fur and dry underlying skin.
Musculoskeletal: Thin, BCS 2/5
Ears: Black/brown debris in both ears
Eyes: 3rd eyelids prolapsed
Lymph nodes: Superficial lymph nodes were reactive
CBC and Chemistry:
PCV = 9.8% (24-45)
Hb = 3.1 g/dl (8-15)
Granulocytes = 2.0x109/L (2.5-12.5)
Platelets = 21 x109/L (175-500)
BUN = 41 mg/dl (18-33)
Creatinine: 2.5 mg/dl (1.1-1.2)
Total protein = 9 g/dl (6.6-8.4)
Other values within normal limits
Appearance = normal
SG = 1.026
No other abnormality noticed in UA.
What is your tentative and differential diagnosis?
What further diagnostic tests you will perform?
What will be your treatment plan?
Solution to this case
||posted by Dr Banga's Websites @ 12:00 AM
Tentative Diagnosis: Hemobartonellosis
Differential diagnosis: Cytauxzoonosis,
Immune mediated hemolytic anemia, Neoplasia of spleen
PCR test for Hemobartenolla, Coombs test for IMHA
Treatment plan: 1. Oxygen therapy
2. Fluid 5% Dextros Sod. Chloride @2ml/kg/hr
5. Blood/Packed cell transfusion
6. Capstar for fleas
7. Prophylactic flea control
8. Cyperoheptadine to stimulate appetite
Thanks Dr. Banga for such a mind stimulating clinical case.
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