Signalment and History: "Sadie," a 6-year-old, 38 kg (84 lb) female spayed Golden Retriever, is presented with the chief complaint that she is "acting old."
The owners report a slow, insidious decline in her energy and activity over the past year. Sadie, who was once an active family dog, is now lethargic, mentally dull, and prefers to sleep most of the day. She has gained nearly 10 lbs in the last year despite the owners being very careful with her diet and not giving her treats.
The owners also have significant dermatologic concerns. Sadie has developed a progressively thinning hair coat over her sides and back. The most dramatic change is the complete hair loss on her tail, which the owner describes as looking like a "rat's tail." Her skin seems flaky, and she has had two ear infections in the last six months, which is unusual for her. The owners state that the hair loss does not seem to bother her; she is not itchy. They are worried about her quality of life and what seems to be premature aging.
Physical Exam:
T: 100.8°F
P: 64 bpm (Bradycardia)
R: 20 bpm
BCS: 7/9 (Overweight)
Mentation: Quiet, calm, and slightly dull.
Sadie is quiet but cooperative for her exam. Her heart rate is slow and regular. The physical exam is most remarkable for its dermatologic findings:
Alopecia: There is a large area of bilaterally symmetrical, non-inflammatory, non-pruritic alopecia over the lateral trunk, lumbar region, and the bridge of her nose. The hair on her tail is almost completely absent, revealing hyperpigmented (darkened) skin underneath.
Coat Quality: The remaining hair coat is dry, brittle, and dull. The hair epilates easily with gentle traction.
Skin: The skin feels slightly thickened and cool to the touch. A mild, greasy seborrhea is present along her dorsum.
Facial Expression: A subtle "tragic" facial expression is noted, caused by mild puffiness of the skin above the eyes.
Initial Diagnostic Workup: A baseline database was established from a fasted blood sample.
Complete Blood Count (CBC): A mild, non-regenerative anemia is present (PCV: 34% [Ref: 37-55%]).
Serum Biochemistry Profile:
Cholesterol: Markedly elevated at 550 mg/dL [Ref: 110-320 mg/dL]
Triglycerides: Markedly elevated at 480 mg/dL [Ref: 50-100 mg/dL]
All other values, including liver and kidney enzymes, are within normal reference intervals.
What will be your tentative and differential diagnosis?
What further diagnostic test(s) you will perform to confirm your diagnosis?
What will be your treatment plan(s)?
Solution for Case 33 will be posted on Sept 26
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