Case Study

03_00028 Shelby S Pericholangitis, fibrosis, biliary hyperplasia

A 3-year-old FS Labrador Retriever dog presented for persistent vomiting and anorexia. Physical examination revealed dehydration, icterus, and tacky mucous membranes. Radiographs were within normal limits. CBC was normal, and blood chemistry analysis demonstrated moderately elevated SAP and moderately elevated ALT, moderately elevated bilirubin and moderately elevated cholesterol, and mild hyperglobulinemia. Serial positive Leptospirosis titers: mildly positive response to Leptospira grippotyphosa and L. autumnalis (1:100) and a moderately positive response to L. bratislava (1:800). Prolonged PT and prolonged aPTT were measured at 20 percent initially but returned to normal after 3 days of supportive hospital care and vitamin K administration.

A 3-year-old FS Labrador Retriever dog presented for persistent vomiting and anorexia. Physical examination revealed dehydration, icterus, and tacky mucous membranes. Radiographs were within normal limits. CBC was normal, and blood chemistry analysis demonstrated moderately elevated SAP and moderately elevated ALT, moderately elevated bilirubin and moderately elevated cholesterol, and mild hyperglobulinemia. Serial positive Leptospirosis titers: mildly positive response to Leptospira grippotyphosa and L. autumnalis (1:100) and a moderately positive response to L. bratislava (1:800). Prolonged PT and prolonged aPTT were measured at 20 percent initially but returned to normal after 3 days of supportive hospital care and vitamin K administration.

DX

Moderate chronic pericholangitis, moderate fibrosis, moderate biliary hyperplasia

Sonographic Differential Diagnosis

Acute inflammatory hepatopathy and, less likely, neoplasia, such as lymphosarcoma. Leptospirosis-induced chronic active hepatitis.

Image Interpretation

The hepatic parenchyma is diffusely and mildly hypoechoic with a coarse echotexture. The intrahepatic portal vascular walls are echogenic with slightly indistinct borders (arrow). There is no evidence of discrete masses or nodules.

Outcome

Positive Leptospirosis on follow-up titers after 5 weeks were mildly positive for L. autumnalis (1:400) and L. icterohemorrhagia (1:200) and strongly positive for L. bratislava (1:6400). The patient responded well to intravenous ampicillin, supportive neutraceutical care, and 6 weeks of doxycycline. The patient was asymptomatic at a 7-week follow-up examination but had mildly persistent SAP and ALT elevations. Further follow-up at 12 weeks revealed a normal physical examination and chemistry profile.

Comments

No video is available for this patient.

Clinical Differential Diagnosis

Hepatitis, biliary obstruction, hepatic neoplasia.

Sampling

16-gauge US-guided biopsy revealed moderate chronic pericholangitis with lymphoplasmacytic and neutrophilic infiltrates, moderate fibrosis, and moderate biliary hyperplasia.