– 3 yr old Min. Aust. Shephard presented for anorexia, vomiting and severely elevated liver enzymes (ALT 2000), elevated bilrubin, mild azotemia and urine SG 1.012; ALB normal
– urine Lepto PCR test and acute Lepto titre test not consistent with Lepto
– liver small on x-ray and on u/s; midly hyperechoic; both kidneys severely hyperechoic corticies, decreased CM distinction (Lepto-like)
– unable to get a safe window for us guided core biopsy therefore performed laparoscopic biopsy – liver small but swollen on gross inspection
– 3 yr old Min. Aust. Shephard presented for anorexia, vomiting and severely elevated liver enzymes (ALT 2000), elevated bilrubin, mild azotemia and urine SG 1.012; ALB normal
– urine Lepto PCR test and acute Lepto titre test not consistent with Lepto
– liver small on x-ray and on u/s; midly hyperechoic; both kidneys severely hyperechoic corticies, decreased CM distinction (Lepto-like)
– unable to get a safe window for us guided core biopsy therefore performed laparoscopic biopsy – liver small but swollen on gross inspection
– histopath results below
– ALT has come down to 800 on Doxycline, but is staying here, and the pet is clinically doing better – I am still concerned about Lepto and am encourging the rDVM to run a convelescent Lepto titre test but the histopath is concerning. Copper testing is pending (this is not that pathologist I usually use as copper is usually automatically tested for)
Any treatment recommendations? I am thinking of adding cyclosporin, ursodiol, liver support drugs (SAMe, milk thistle, hepatosupport) adding in amoxicillin?
Comments
In a 3 year old copper would
In a 3 year old copper would nbe my first guess if not toxin. Most pathologists when you talk to them they will bleed out the real need for copper staining or not whether its primary copper that needs chelating or secondary copper from inflammation.
Liver diet ampicillin for lepto, metronidazole and neutraceuticals is what I would do. No other toxins like mushrooms or plants in the hx right?
Lower left intercostal would have been the approach I would have taken for US guded bx but you got there with chunks on the scope so I would ride that histopath all you can and squeaze out all the info and second opinions you can. Maybe throw it to sharon center at cornell she will laod you with tons of info and what to do regarding diet adjustments and neutraceuticals that count.
I thought about consulting
I thought about consulting with Sharon Center-I know many use her exclusively for liver – may be good to get a second opinion on this one.