13 year old FS Australian Shepherd. Two months ago, liver enzymes were markedly elevated -ALT 5737, AST 1680, ALP 4986, GGT 8, T bilirubin 2.6. She was lethargic and anorexic at the time. Potentially had eaten some toxic mushrooms (Lepiota spp). Positive for anaplasma and Lyme on 4DX, positive lepto titer (no convalescent taken) and negative on Lepto PCR. Had been vaccinated for Lepto. Was on antibiotics, ursodiol and denamarin. Liver values made a big improvement as did her clinical status. Recently liver values climbed again, but patient not showing any symptoms (recent ALT in the 500’s).

The parenchyma looks neoplastic to me. I’m wondering if the cystic areas could be areas of necrosis or abscesses. We are likely going to proceed with FNAs next week (coags pending), but would love any input on differentials and how you would proceed.