Case Study

Presumptive protein-losing enteropathy, inflammatory bowel disease, or lymphoma in a 6 year old hound mix dog

A 6-year-old female spayed Hound mix dog was presented for decreased appetite, increased drinking, and watery diarrhea for 4 days. Physical exam found soft, fluid filled bowels on abdominal palpation. An anti-diarrheal injection was administered, and the patient was discharged with oral anti-diarrheal medication, along with Tylan powder. Approximately 1 week later, the patient presented for persistent decreased appetite, lethargy, and watery stool.

A 6-year-old female spayed Hound mix dog was presented for decreased appetite, increased drinking, and watery diarrhea for 4 days. Physical exam found soft, fluid filled bowels on abdominal palpation. An anti-diarrheal injection was administered, and the patient was discharged with oral anti-diarrheal medication, along with Tylan powder. Approximately 1 week later, the patient presented for persistent decreased appetite, lethargy, and watery stool. Physical exam found patient bright and alert, with pink mucous membranes, normal CRT, heart and lungs clear, a slightly distended abdomen, and no palpable masses found. Blood chemistry revealed hypoproteinemia, hypoalbuminemia, hypocalcemia, and hypocholesterolemia. CBC found high platelet count. Fecal was negative.

DX

Presumptive PLE, IBD or lymphoma

Sonographic Differential Diagnosis

Ascites, hypoalbuminemia, and mucosal striations all suggests protein losing enteropathy. Likely inflammatory bowel disease and enteritis with potential for emerging intestinal lymphoma. The corn oil test to dilate the lacteals and help reveal lymphangectasia with endoscopic or surgical biopsies would be warranted.

Image Interpretation

Diffuse intestinal wall thickening was evident with vertical hyperechoic mucosal striations. Reactive hyperechoic surrounding fat associated with the serosa suggests a transmural pathology with adhesions likely.

Outcome

A plasma transfusion was recommended. Medium chain triglyceride oil, prednisone, metronidazole, and vitamin B injections were suggested for patient. Owner elected to euthanize patient due to guarded prognosis and poor quality of life.