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.