Cocker Spaniel with TCP/hepatopathy/pyrexia etc...

Re: Cocker Spaniel with TCP/hepatopathy/pyrexia etc...

Laurence Webb — Thu, 03 Feb 2011 12:49:04 GMT

Sad outcome but interesting.

Might a possible sequence be the cutaneous lymphoma causing a glomerulonephritis (high UPC). Along with albumin loss you can lose antithrombin through the kidney. Spontaneous thrombus formation would have resulted in the thrombocytopaenia. Death could have been due to an embolus if it went peacefully in its sleep.

Re: Cocker Spaniel with TCP/hepatopathy/pyrexia etc...

Richard Fox — Thu, 03 Feb 2011 11:40:03 GMT

Damn - Oh well - nice to learn a thing or two - well not much you could do really! Bloomin skin lymphoma, looks like a dermatitis until you bx it :)

Thanks for the update :)

Re: Cocker Spaniel with TCP/hepatopathy/pyrexia etc...

Alice Courtney — Thu, 03 Feb 2011 11:17:30 GMT

Thought I'd post the outcome of this interesting case...

Dog became brighter and clinically well with supportive treatment, platelet count went back to normal as did cPLI. The enlarged SMLN went down pretty much to normal. However, hepatopathy and skin lesions remained (generalised, erythematous, flaking). Coagulation profile + CBC was normal but there were still strange red echymoses-like lesions on the gingiva. Liver biopsy showed mild hepatitis. Skin biopsy showed cutaneous lymphoma. The dog died suddenly at home (seemingly in it's sleep?) on the very day the histology results came back...Very sad, was a lovely Cocker and lovely owners. Still, at least I could give them an answer. I just hope I hadn't hastened her demise with the liver biopsy, although her PCV the following day was normal.

Re: Cocker Spaniel with TCP/hepatopathy/pyrexia etc...

Martin Atkinson — Thu, 09 Dec 2010 12:01:15 GMT

Regardless of the cause of the TCP if platelet count is so low its causing echymoses and peteciae there is a danger of a catastrophic bleed-out. IME, a single dose of vincristine or vinblastine at half chemotherapeutic dose will release platelets from the bone marrow with little or none of the myelosuppressive effects associated with full dose with spectacular effect on PLT count. If it has got lymphoma thats probably the way to go anyway. Have you thought about sending blood for lymphoma markers?

Re: Cocker Spaniel with TCP/hepatopathy/pyrexia etc...

Alice Courtney — Thu, 09 Dec 2010 08:11:37 GMT

UPDATE:

ANA serology NEGATIVE

Urine culture NEGATIVE, no active sediment, urine Protein:creatinine 9.2 (!)

cPLI 732 HIGH consistent with pancreatitis

FNA cytology of mass at angle of jaw: possibly reactive, however cluster of monomorphic blast cells could be lymphoma...

Examination: annoyingly the dog was booked in the a different vet for its recheck, so blood tests were not repeated however the dog is doing well, eating, bright, and the mass is shrinking. However temperature is still 39.6, and as I don't have blood tests I have no idea what's happening to the platelets or liver parameters. Needless to say I have re-arranged the next checkup to be with me....I'll keep you posted.

Re: Cocker Spaniel with TCP/hepatopathy/pyrexia etc...

Bob Russell — Thu, 02 Dec 2010 14:36:45 GMT

We now have a rule of thumb here - if we cannot find anything else wrong it is pancreatitis until proven otherwise.

Are we just looking for it more or is it on the increase?

Re: Cocker Spaniel with TCP/hepatopathy/pyrexia etc...

Utlendigur — Thu, 02 Dec 2010 13:42:23 GMT

I thought at first you'd inherited a Cocker spaniel I was treating at various points earlier in the year - persistent pyrexia, petichiae/ecchymoses, intermittent hypercalcaemia with no apparent cause, pancreatitis, perianal mass (not anal gland), cough, ears, skin, etc etc. I discovered that Cockers are known for immune mediated thrombocytopenia (and pancreatitis). But that one was male - and seemed to settle after treating the initial acute pancreatitis, then steroids for the immune-mediated thrombocytopenia. Just wondering whether it could be something like SLE?

Re: Cocker Spaniel with TCP/hepatopathy/pyrexia etc...

Alice Courtney — Thu, 02 Dec 2010 13:04:56 GMT

Hi thanks Richard, to answer your queries:

platelets 2d later were 45. Both times smears done by our lab had no comment re abnormal morphology, but haven't sent smear to specialist...

No neutrophilia, no toxic/left shift on smear. I agree it doesn't have an inflammatory leucogram which is interesting considering possible infectious/immune-mediated disease.

Yes had occurred to me that more than one disease entity confusing the picture, hence keeping very open mind. Luckily understanding and intelligent owners attached

Re: Cocker Spaniel with TCP/hepatopathy/pyrexia etc...

Richard Fox — Thu, 02 Dec 2010 12:53:18 GMT

I think I would want to repeat platelet count esp if other bloods are normal RE: clumping. I presume platelet morph was normal?

Pyrexia usually indicates inflammation/infection esp when profound.

Also surprised there is no neutrophilia but I wonder if we have a consumptive disorder that might coincide with the lymphopaenia?

Immune-mediated TCP would be of concern though if platelets are def. reduced but also this can be consumptive. TCP was also not the original complaint?

Skin lesions seem poss old - i.e. crusting? but Haemorrhages maybe d.t. TCP or sepsis/inflamm etc.

I wouldn't bother aspirating the spleen unless it is markedly enlarged and homogenous - live aspirates maybe useful but probably indicates vacuolar hepatopathy if the its diffusely enlarged and homgenous?

I wonder if we have several different diseases going on and overlapping?

Re: Cocker Spaniel with TCP/hepatopathy/pyrexia etc...

Alice Courtney — Thu, 02 Dec 2010 12:19:04 GMT

SORRY didn't realise how long this was!