The patient responded well to IV fluid support, plasma expander therapy and intravenous antibiotics. Outpatient therapy included triple antibiotic therapy and supportive care. A single dose of dexamethazone was also administered. The patient thrived over the following 2 weeks when the follow-up sonogram was performed demonstrating a 50% reduction in the avascular hypoechoic pancreatic lesion. The patient was essentially asymptomatic at this time. Antibiotics were continued for an additional 3 weeks. Seven days after the antibiotics were stopped the patient presented again with lethargy and anorexia. Repeat ultrasound revealed that a splenic abscess had now formed (Image 3). The patient was again hospitalized and discharged 3 days later responding to enrofloxacin and D-methionine therapy.
Surgical biopsies were taken 2 months later (owner request) to further define the pathology. The patient was essentially stable at that time. Surgically-obtained histopathology 2 months post follow-up sonogram revealed the following:
1. Pancreatic nodular hyperplasia
2. Severe chronic lymphoplasmacytic cholangiohepatitis
3. Mild, chronic, lymphoplasmacytic enteritis
4. Moderate, chronic, fibrosing inflammation and splenic adhesion
5. Mild chronic, proliferative, mesenteric lymphadenopathy.
6. Mild, chronic, ulcerative, fibrosing cystitis.
The patient recovered uneventfully and was stable without medication 2 months post exploratory surgery.