- 5 year old FS Greyhound presented to rDVM 3 weeks ago for neck pain, lethargy, and weight loss
- PE showed petechia and echymoses
- Blood work showed a severe thromboyctopenia (10,000), rest of labwork was wnl included 4DXT-all neg
- The patient was treated with prednisone, atopica, famotidine, and doxycycline
- The platelet count increased to 250,000 then decreased to 110,000 after the owners decreased the pred dose on their own.
- 5 year old FS Greyhound presented to rDVM 3 weeks ago for neck pain, lethargy, and weight loss
- PE showed petechia and echymoses
- Blood work showed a severe thromboyctopenia (10,000), rest of labwork was wnl included 4DXT-all neg
- The patient was treated with prednisone, atopica, famotidine, and doxycycline
- The platelet count increased to 250,000 then decreased to 110,000 after the owners decreased the pred dose on their own.
- Abdominal ultrasound shows splenomegaly, increased splenic echogenicity, coarse parenchyma, and some mild congestion of the splenic and hepatic veins.
- Chest radiographs are nonremarkable. Echocardiogram shows no cardiac masses and no pleural or pericardial effusions.
- Cardiac measurements are as follows: IVSd=16.1, LVIDd=50, LVPWd=16, IVSs=17, LVIDs=39, LVPWs=17, FS=23%.
- My primary differentials are immune mediated thrombocytopenia (primary and secondary), neoplasia (LSA, MCT), and less likely bone marrow disease (all other cell lines are within normal limits)
- The confusing part is this dog continues to lose weight (10-12% BW) despite a good appetite. Can ITP cause weight loss? Could this be atopica, or is neoplasia more likely? Splenic fna’s are pending.
Comments
This looks structurally like
This looks structurally like uniform hypersplenism but LSA or similar masked by pred is entirely possible. LSA can give secondary ITP or even evans syndrome. Need to get platelet ct > 70k then fna. Ensure not other signs of LSA are present by checking chest rads and cranial mediastinul and regional LN. I would fna th eliver as well no matter what it looks like and image th eportal hilus well for an hepatic lymphadenopathy. 10k platelets is really low for infectious like ehrlichia.
Maybe Remo has ore insight on the infectious side..
Great workup. Would not
Great workup. Would not associate weight loss with IMT. Although infectious diseases can certainly give secondary IMT, with the good response to preds and the subseqent drop in platelets when the dose was dropped and the ongoing splenomegaly, hypersplenism would be my first diagnosis. Is the neck pain still present? as discospondylitis (bacterial/fungal) is possible. Agree that spleen and liver needs to be aspirated. Splenectomy is often indicated for hypersplenism but usually do a bome marrow aspirate first to ensure that the bone marrow is functioning.