8/11/2019 Case Report, Charlie W.

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Case Report

Signalment: Charlie, 13 y/o castrated male, Border Collie mix, weighing 23.4kgs

Clinical History: Charlie presented to his primary care veterinarian on August 5, 2014, ADR

with anorexia and lethargy. Blood work performed on 8/5/14 showed a packed cell volume of

30%, total solids of 5.0 g/dL and clear serum. An in-house fecal flotation was performed to ruleout intestinal parasites; an Idexx 4Dx SNAP test was performed to rule out tick-borne disease; no

oocysts were seen on the fecal examination, and the SNAP test was negative for E.

Canis/E.Ewingii, Anaplasmosis, D. Immitis, and B. Burgdorferi. Charlie was started on

Minocycline 100mg, 2 capsules PO BID for 10 days in case of falsely negative results.

On 8/7/14, Charlie presented to the ICU for lethargy and anorexia. Upon initial examination, he

was found to be febrile, with a temperature of 103.5 F. Initial blood work revealed pancytopenia

and light straw-colored serum; PCV/TS = 28%/4.7g/dL; WBC = 3400 u/l; and 3-5 platelets/HPF.

Antech PCR tick disease and lyme serology were performed and returned negative for tick-borne

diseases. An abdominal ultrasound was performed and revealed splenomegaly. Aspirates of the

spleen were taken and analyzed. Lymphoid hyperplasia, extramedullary histiocytes,

hematopoiesis differentiation and erythrophagocytosis without cancerous indications was

observed.

On 8/9/14 a bone marrow aspirate was performed on each humerus. Aspirates revealed primarily

blood. In-house diagnostics revealed excessive fat (indicative of decreased marrow activity) and

a decrease the number of cells, with few precursor cells. No cancerous cells were noted. Antech

diagnostics of the aspirates revealed polychromatophilic red blood cells, marrow and stromal

cells devoid of hematopoietic precursors, few plasma cells, small marrow spicules,

megakaryocytes, marked myeloid hypoplasia, and possible myelofibrosis.

Doxycycline 100mg BID for the treatment of ehrlichiosis was prescribed, as the minocycline had

been causing Charlie to vomit. Owner was advised to continue Vitamin B12 treatment and was

also given Cerenia 60mg PO SID x 4d and Tramadol 50mg PO up to TID PRN.

On 8/20/14, Prednisone 20mg PO SID was prescribed.

Presenting Signs: Charlie presented to the ICU on August 27, 2014 at 7:26 AM. At 2:30 AM

the same day, the owner notice that Charlie was unable to stand; he was carried in to the hospital

by the owner at the time of presentation. The owner stated that his appetite and water intake have

been normal and no episodes of vomiting or diarrhea had occurred.

Physical Examination: T: 105.4 F. P: 130bpm, femoral pulses strong and synchronous, mildtachycardia. R: Panting, mildly elevated respiratory effort. MM/CRT: pink, 1 second, normal

hydration, slightly increased salivation. LOC: Quiet, depressed, responsive. Patient weak and

ataxic, requiring support to stand and walk. Mild epistaxis and petechiation observed.

Laboratory Tests: CBC performed, revealing 0-3 platelets/HPF and continued pancytopenia.

Diagnosis: Pancytopenia, splenomegaly, anemia

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Treatment: Patient was immediately started on LRS 1x maintenance, at 63 mL/hr. His vital

signs were monitored q1h for the first 4h, then q4h. 2 tbsp of Royal Canin GI Low Fat Diet

offered q4h and appetite monitored. Walks q4h. Unasyn 515mg administered IV q8h.

Prognosis: Guarded to poor with appropriate course of treatment. Recommend PRBC

transfusion and plasma transfusion. Patient continues to experience a high fever despite course ofbroad-spectrum antibiotics. His appetite has been good and he has eliminated well when walked

outside, however he has remained weak and depressed.

Outcome: Charlie was humanely euthanized on 8/29 due to a combination of his guarded

prognosis and owner financial constraints.