Case 21

A 4 year old intact male pit-bull mix canine  was presented to ACaseAweek Clinic for generalised weakness and a swollen left hindlimb since one week. He is both indoor and outdoor and he is fed home made food which is mainly rice and chicken. He is upto date on vaccination, heartworm and ectoparasites control.

Physical Exam:
Weight 25.1Kg
T: 100.9*F
PR/HR: 90bpm
RR: 36bpm
MM: Pale
CRT: >2sec
EENT: Normal
M/S – Swollen hind limb with pitting edema that is not painful.
Thorax: Muffled heart sounds on auscultation, but regular with no arrhythmias or murmurs noted.  Possible diminished lung sounds.
Abdominal palpation – Enlarged abdomen, with fluid wave on palpation.
LN: wnl
Neuro,  rectal – not examined.
BCS:  2/5

CBC and Chemistry:PCV 27% ( 37-55)
RBC morphology: mild anisocytosis and normochromic – non regenerative
No microfilaria seen,
All other values: wnl
ALB 1.9 g/dl (2.3 -4.0)
BUN 33 mg/dl (7-27)  
Creatinine: 1.7 mg/dl (0.5-1.6)
TP 4.8 g/dL (5.2 -8.2)
Urinalysis (free catch):Mild odor,
Color: yellow
SG: 1.020
Radiographs (Click to enlarge):

 

What are radiographic and ultrasound findings?What is your tentative and differential diagnosis?
What further diagnostic tests you will perform?
What will be your treatment plan?

Solution to this case

Solution to case 20

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Tentative diagnosis: FIV/FeLV

Differentials: FIV, FeLV, hemobartonella, cytoxazoon, Eosinophilic granuloma complex, superficial pyoderma, IMHA, hyperthyroidism, renal disease. 

Further diagnostic tests:IDEXX Combo FIV/FeLV snap test, blood smear for blood protozoa, impression smear of the oral lesions, skin scraping and bacterial culture and sensitivity for the skin lesions. T4 test. PCR test for hemobartonella is also available. 

In this case the IDEXX combo test was positive for FeLV. No blood protozoa was seen on the blood smear. No eosinophils were seen on the impression smear of the oral cavity. Skin scraping was negative. Culture for skin lesions was positive for Staph infection and sensitive to Potentiated Amoxicillin. T4 levels were normal.

Based on the clinical signs and results from CBC and IDEXX snap test, FeLV is at the top of the differential list.  Her general appearance, lethargy, skin condition and lymphadenopathy all are signs that the immune system is not functioning optimally. Increase in the BUN/Creatinine and total proteins is due to dehydration. 

FeLV is a retrovirus in the same family as HIV/AIDS in humans.  It is more common in outdoor cats and kittens.  It is transmitted primarily through saliva from sharing utensils or from bite wounds and licking.  It can also be transmitted via urine, tears, feces, milk and through placenta.   Its main effect is suppression of the immune system thus affected individuals have many other organ system issues. 30% of animals develop cancer (lymphosarcoma).  This virus also leads to bone marrow suppression thus this animal had non-regenerative anemia, leucopenia and thrombocytopenia. Animals can live for years with the disease but usually by the time the diagnosis is made, the cat is already viremic.  Expected lifespan is 1-2 years after diagnosis.
IDEXX combo snap test for FeLV needs to be repeated in six weeks or Immunoflourecent Antibody (IFA) test needs to be done to confirm the diagnosis.  

Treatment Plan:
Blood transfusion was done and supportive therapy was provided as follows:  
IV fluids - LRS
Antibiotics - Potentiated Amoxicillin
B-complex
a/d Hills diet (high nutrition diet for recovering sick animals)

Advised to keep the cat indoors and prevent being around others both so they are not possibly exposed to FeLV. Any secondary infections should be treated as soon as possible. FeLV in this case was repeated in six weeks and was still positive thus confirming the diagnosis.