INTERNAL MEDICINE Beth Lechner, DVM, DACVIM
Name: Rocco
Age: 4 years
Breed: Pitbull
Gender: Male
History: Presented for severe lethargy and weakness, vomiting, anorexia, pigmenturia, and diarrhea
Exam: Diffuse peripheral LN enlargement, severe weakness, dehydration, tachycardia
Initial Diagnostics:
Labwork: Azotemia (BUN 50, Creat 3.4), hypoglycemia, neutrophilia with left shift, mild thrombocytopenia
Radiographs: concern for possible disk spondylitis
Abdominal ultrasound:
- Inguinal and medial iliac LN enlargement
- Right adrenomegaly
- Cystic calculi, non-obstructive
Leptospirosis Ab positive
Digital cytology from enlarged LN - reactive lymphoid hyperplasia
Results that came back several days later:
Leptospirosis Ab positive, PCR negative
Urine culture - positive
Summary:
The patient was admitted to the hospital in critical condition. Initial workup revealed dehydration, azotemia, hypoglycemia, and enlarged lymph nodes. Was treated for dehydration, suspected infection, and possible Lepto. His condition was not improving. The owners had significant financial limitations and were strongly considering euthanasia, especially since we were concerned about possible neoplasia. We encouraged them to perform cytology on Enlarged lymph nodes before making the difficult decision. Aspirated lymph node and used our new digital cytology capabilities discovered that lymph nodes were indeed reactive and no cancer cells were seen. This motivated the owner to give him one more day of treatment. By the next day, he turned the corner and started to improve. He was ultimately discharged and patient follow-up revealed that he was thriving at home! Without fast turnaround cytology, he would have been euthanized.
