Case discussion: anorexia and mild intermittent pyrexia (FN Irish setter 6 years 6 months)

RE: Case discussion: anorexia and mild intermittent pyrexia (FN Irish setter 6 years 6 months)

Andrew Kent — Sun, 10 Mar 2019 07:45:30 GMT

There are some cases with poor correlation between histo severity and clinical signs but I agree mild changes are difficult to interpret. Often more severe changes seen in other areas of the GI tract which is why ileal biopsies via lower GI scope can be helpful.

Time will tell whether we are on the right track anyway :-)

Andy

RE: Case discussion: anorexia and mild intermittent pyrexia (FN Irish setter 6 years 6 months)

Sara Ramsey — Fri, 08 Mar 2019 16:58:23 GMT

I think I was suspecting the raised Cpli was secondary to something. I suppose an enteropathy would fit although the histo changes were mild. I haven't seen a patient present in this way though with just anorexia and weight loss. However, that doesn't rule IBD out.

RE: Case discussion: anorexia and mild intermittent pyrexia (FN Irish setter 6 years 6 months)

Andrew Kent — Fri, 08 Mar 2019 16:39:14 GMT

[quote user="Thomas Johnson"]

[quote user="Andrew Kent"]An inflammatory disease, such as an inflammatory enteropathy, is perhaps more likely and some of these dogs can present with primarily appetite changes.[/quote]

And could the elevated Spec cPL be secondary to intestinal changes rather than a primary pancreatitis?

[/quote]

Agree its not uncommon to see elevated cPLI for other reasons such as in association with an enteropathy so would be a reasonable possibility in this case.

RE: Case discussion: anorexia and mild intermittent pyrexia (FN Irish setter 6 years 6 months)

Thomas Johnson — Fri, 08 Mar 2019 08:22:07 GMT

[quote user="Andrew Kent"]An inflammatory disease, such as an inflammatory enteropathy, is perhaps more likely and some of these dogs can present with primarily appetite changes.[/quote]

And could the elevated Spec cPL be secondary to intestinal changes rather than a primary pancreatitis?

RE: Case discussion: anorexia and mild intermittent pyrexia (FN Irish setter 6 years 6 months)

Sara Ramsey — Thu, 07 Mar 2019 20:25:30 GMT

Thank you, it was a tough few weeks! Lovely dog and and lovely owners (aren't they always)...I'd never been presented with a dog who appeared to be starving herself!

I keep forgetting about CRP...need to do some refresher reading!

RE: Case discussion: anorexia and mild intermittent pyrexia (FN Irish setter 6 years 6 months)

Andrew Kent — Thu, 07 Mar 2019 19:25:28 GMT

Hi Sara,

Some of these vague cases are tough.

Ultimately you have a steroid responsive disease (and not even a particularly high dose) so the specific disease may not be important.

An immune-mediated disease is possible although we often see higher body temperature and more obvious other symptoms (ie joint pain) but not always. These diseases can wax and wane which makes them very frustrating. Measurement of c-reactive protein can be helpful in those patients as usually fairly elevated. The argument against this for me would be the slightly unimpressive temperatures and the response to a fairly low steroid dose.

An inflammatory disease, such as an inflammatory enteropathy, is perhaps more likely and some of these dogs can present with primarily appetite changes.

Another possibility would be a naturally waxing and waning disease which has improved naturally. You don't mention the basal cortisol result but presumably high enough to exclude an atypical hypoadrenocorticism?

Ultimately I would likely continue the steroid then slowly taper and see what happens. I might also be tempted to start a strict diet trial with a novel protein hydrolysed diet for possible food-responsive enteropathy.

The situation may become clearer with time as it flares up or doesn't in the future!

Andy

RE: Case discussion: anorexia and mild intermittent pyrexia (FN Irish setter 6 years 6 months)

Sara Ramsey — Thu, 07 Mar 2019 17:35:41 GMT

Thank you for the reply!

She had her mouth examined conscious several times and because she is head shy we had a good look when under GA. The CT scan was interpreted via Vet CT and "rest of skull was normal" . I did consider dental disease hence another reason for CT scanning the head.

RE: Case discussion: anorexia and mild intermittent pyrexia (FN Irish setter 6 years 6 months)

Rob Davis — Thu, 07 Mar 2019 17:17:30 GMT

Scan read, so apologies if I've missed something which rules this out, but oral pain? Reluctance to eat seems to be the main presenting sign. Has the head CT been thoroughly evaluated for signs of endodontic disease?