8 year old MN Shep mix with severely elevated liver values, severely icteric. Previous medical record indicated some elevated Lepto titers, but a convalescent sample had not risen enough to declare and infection (2021). The dog had been on Clavamox, doxy and Denamarin.
Could this liver appearance be chronic Lepto infection? I did a FNA, but came back hepatocellular vacuolation with moderate atypia and disorganization, marked cholestasis. No current Lepto test was ever submitted and the dog was eventually euthanized.
Comments
With the elevated liver enzymes, icterus, and the ultrasound appearance chronic-active hepatitis neoplasia (primary or infiltrative), and granulomatous disease would be likely etiologies. Tru-Cut or wedge biopsy often required for a diagnosis.
Generally leptospirosis causes acute hepatitis, which can with time as there can be self perpetuating changes within the liver (oxidative changes, immune-mediated, accumulation of copper and iron, etc) result in chronic hepatitis but usually is not of a chronic-active process.
Thank you very much for the input. For granulomatous disease, could Lepto be an underlying cause? How would I expect it’s appearance to differ from this image? For a chronic Lepto case, what are the typical characteristics on ultrasound?
Unfortunately there are no typical abdominal ultrasound findings for leptospirosis.