Canine Infectious Diseases PDF

Self-Assessment Color Review
Canine Infectious Diseases

Self-Assessment Color Review
Canine
Infectious
Diseases
Katrin Hartmann
Professor Dr med vet, Dr habil
Diplomate ECVIM-CA (Internal Medicine)
Head of the Clinic of Small Animal Medicine
Centre for Clinical Veterinary Medicine
Ludwig Maximilian University Munich, Germany
Jane Sykes
BVSc, PhD
Diplomate ACVIM (Small Animal Internal Medicine)
Professor of Small Animal Internal Medicine
School of Veterinary Medicine
University of California-Davis, USA
CRC Press
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Contents
Preface........................................................................................................ vii
Contributors................................................................................................ ix
Picture acknowledgments............................................................................ xi
Abbreviations............................................................................................. xiii
Broad classification of cases........................................................................ xv
Questions.......................................................................................................1
Answers.....................................................................................................133
Conversion factors.................................................................................... 265

Index......................................................................................................... 267
v
Preface
Infectious diseases are very common in companion animals and the dog is at
the forefront of emerging and newly discovered infections. Dogs also have been
implicated in zoonoses and the spread of infections to and from wildlife.
In this book, we have provided an overview of canine infectious diseases in a
case-based manner in the way clinicians encounter them in daily practice all over
the globe. Because of the global nature of the case descriptions, several unique
cases and images that have not been published elsewhere in the scientific literature
can be found in this book. We hope this practice-oriented approach motivates the
reader to contemplate the cases and to reflect on how they might have managed
each case themselves.
The book was created for veterinary practitioners and veterinary students during
their clinical rotations, to improve and practice their knowledge of infectious
diseases. At the end of every case, questions for self-assessment by the reader are
provided to test existing knowledge. The illustrations that accompany each case
will help the reader to identify both classical and unique disease presentations.
We are very grateful for the expertise and hard work of all our co-authors.
Further, we are extremely thankful to Monika Freisl for her hard work in providing
the final editing of case descriptions and for acting as a point of liaison with
co-authors. We would also like to thank the whole team at CRC Press for their
patience and encouragement. Most of all we would like to thank our partners,
families, friends, and colleagues in our teaching institutions for all their support
and encouragement to turn this book into reality.
We invite the readers to approach this book in the way we approach each of
our canine patients, as a series of mysteries awaiting our careful detective work in
search of a happy outcome for our patients and the families that care for them.
We hope that this book will inspire veterinarians to embrace the topic of canine
infectious diseases and to contribute to the health and welfare of dogs everywhere.
Katrin Hartmann and Jane Sykes
vii
Contributors
Ursula M. Dietrich Daniel Guimarães Gerardi
Professor Dr med vet, MRCVS DVM, MS, PhD
Diplomate ACVO Departamento de Medicina Animal
Diplomate ECVO Faculdade de Veterinária
Royal Veterinary College Universidade Federal do Rio Grande
North Mymms, Hertfordshire, UK do Sul (UFRGS)
Porto Alegre, Brazil
Pedro Paulo Vissotto de Paiva Diniz
DVM, PhD Bernhard Gerber
Associate Professor of Small Animal Priv-Doz, Dr med vet
Internal Medicine Diplomate ACVIM
College of Veterinary Medicine Diplomate ECVIM-CA
Western University of Health Sciences (Internal Medicine)
Pomona, California, USA Vetsuisse Faculty
University of Zurich
René Dörfelt Zurich, Switzerland
Dr med vet
Diplomate ECVAA Craig E. Greene
Clinic of Small Animal Medicine DVM, MS
Centre for Clinical Veterinary Medicine Diplomate ACVIM (Internal Medicine
Ludwig Maximilian University and Neurology)
Munich, Germany Emeritus Professor, Departments
of Small Animal Medicine and
Andrea Fischer Infectious Diseases
Professor Dr med vet, Dr habil College of Veterinary Medicine
Diplomate ECVN University of Georgia
Diplomate ACVIM (Neurology) Athens, Georgia, USA
Clinic of Small Animal Medicine
Centre for Clinical Veterinary Medicine Katrin Hartmann
Ludwig Maximilian University Professor Dr med vet, Dr habil
Munich, Germany Diplomate ECVIM-CA
(Internal Medicine)
Tadeusz Frymus Clinic of Small Animal Medicine
Professor Dr med vet Centre for Clinical Veterinary
Head of the Division of Infectious Medicine
Diseases Ludwig Maximilian University
Department of Small Animal Diseases Munich, Germany
Faculty of Veterinary Medicine
Warsaw University of Life Sciences
(SGGW)
Warsaw, Poland
ix
Lynelle Johnson Jane E. Sykes
BA, DVM, MS, PhD BVSc(Hons), PhD
Diplomate ACVIM (Internal Diplomate ACVIM
Medicine) Professor of Small Animal Internal
Professor, Medicine & Epidemiology Medicine
University of California-Davis School of Veterinary Medicine
Davis, California, USA University of California-Davis, USA
Ralf S. Mueller Stefan Unterer

Professor Dr med vet, Dr habil Priv.-Doz., Dr med vet, Dr habil
Diplomate ACVD Diplomate ECVIM-CA (Internal
Diplomate ECVD Medicine)
Clinic of Small Animal Medicine Clinic of Small Animal Medicine
Centre for Clinical Veterinary Centre for Clinical Veterinary Medicine
Medicine Ludwig Maximilian University
Ludwig Maximilian University Munich, Germany
Munich, Germany
Gerhard Wess
Maria Grazia Pennisi Professor Dr med vet, Dr habil
DVM, PhD Diplomate ACVIM (Cardiology)
Specialist in Applied Microbiology Diplomate ECVIM-CA (Cardiology)
Department of Veterinary Sciences Diplomate ECVIM-CA (Internal
Polo Universitario dell’Annunziata Medicine)
University of Messina Clinic of Small Animal Medicine
Messina, Italy Centre for Clinical Veterinary Medicine
Ludwig Maximilian University
Bianka Schulz Munich, Germany
Priv.-Doz., Dr med vet, Dr habil
Diplomate ECVIM-CA (Internal
Medicine)
Clinic of Small Animal Medicine
Centre for Clinical Veterinary
Medicine
Ludwig Maximilian University
Munich, Germany
x
Picture acknowledgments
4: courtesy of Craig Greene, © University of Georgia Research Foundation Inc.
10a, b: courtesy of Prof. Antonio Vicente Mundim
12: courtesy of the University of California-Davis, Veterinary
Ophthalmology Service
13a, b: courtesy of the University of California-Davis, Veterinary Medical
Teaching Hospital
16: courtesy of Dr. Suzane Beier
17a, 17b: courtesy of Dr. Cynthia Lucidi
23: courtesy of Chirurgische und Gynäkologische Kleintierklinik, LMU Munich
27: courtesy of the Clinical Laboratory, Vetsuisse Faculty, University of Zurich
28: courtesy of M. De Majo
29a, 29b: courtesy of G. Mazzullo
60a, 60b: courtesy of Dr. Gary Johnston
61a: courtesy of Dr. Gary Johnston
61b: courtesy of Kristin Nunez
74: courtesy of Prof. Dr. Tricia Maria Ferreira de Souza Oliveira
88: courtesy of Dr. Matt Eberts
92: courtesy of G. Lombardo
107: courtesy of the University of California-Davis, Veterinary Medical
Teaching Hospital
113: courtesy of Teton New Media
115a, b: courtesy of Mark Kent, © University of Georgia Research Foundation Inc.
117a, 117b: courtesy of Dr. Matt Eberts
118: courtesy of Dr. Kristin Nunez
127a, 127b: courtesy of Craig Greene © University of Georgia Research
Foundation Inc.
128: courtesy of the Department of Veterinary Pathology, UGA, © University of
Georgia Research Foundation Inc.
133a, b: courtesy of Prof. Dr. Rafael Fighera
134: courtesy of Prof. Dr. Rafael A. Fighera
136: courtesy of the University of California-Davis, Veterinary Cardiology
Service
139: courtesy of M. Masucci
140a, 140b: courtesy of M. De Majo
145: courtesy of Jacek Brzeski
146: courtesy of Jacek Brzeski
Teaching Hospital
xi
154a, 154b: courtesy of Dr. Mitika Hagiwara
155a, 155b: courtesy of Flavio Paz
157: courtesy of the University of California-Davis Veterinary Medical
Teaching Hospital
168: courtesy of the Department of Veterinary Pathology, UGA, © University of
Georgia Research Foundation Inc.
172: courtesy of Dr. Matt Eberts
180a, 180b: courtesy of Chirurgische und Gynäkologische Kleintierklinik,
LMU Munich
182a, 182b: courtesy of G. Malara
191: courtesy of Dr. Cynthia Lucidi
Teaching Hospital
199b: courtesy of Dr. José Luis Laus and Dr. Ivan Martinez
xii
Abbreviations
ALP alkaline phosphatase IRIS International Renal Interest
ALT alanine aminotransferase Society
aPTT activated partial IM intramuscular(ly)
thromboplastin time IMHA immune-mediated hemolytic
AST aspartate aminotransferase anemia
BAL bronchoalveolar lavage IV intravenous(ly)
BCS body condition score MCHC mean cell hemoglobin content
bpm beats per minute MCV mean cell volume
BUN blood urea nitrogen MRI magnetic resonance imaging
CBC complete blood count OD right eye (oculus dextrus)
CFU colony-forming units OS left eye (oculus sinister)
CNS central nervous system PCR polymerase chain reaction
CRI continuous rate infusion PO orally (per os)
CSF cerebrospinal fluid PT prothrombin time
CT computed tomography PU/PD polyuria/polydipsia
DIC disseminated intravascular RBC red blood cell(s)
coagulopathy RI reference interval
DNA deoxyribonucleic acid RNA ribonucleic acid
ECG electrocardiography/ SC subcutaneous(ly)
electrocardiogram T4 thyroxine
ELISA enzyme-linked immunosorbent TSH thyroid-stimulating hormone
assay UPCR urine protein to creatinine
GABA gamma-aminobutyric acid ratio
hpf high-power field UV ultraviolet
IFA immunofluorescence assay WBC white blood cell(s)
Ig immunoglobulin
xiii
Broad classification of cases
Bacterial infections Cryptococcosis 12, 13
Anaplasma phagocytophilum Fungal pneumonia 176
infection 117, 118, 119 Histoplasmosis 39, 179
Anaplasma platys infection 16, 17, Pythiosis 167, 168
18, 19 Skin fungal infections 4, 5, 67, 110,
Bacterial pneumonia 25, 26, 121, 122 111, 112, 113, 181, 182
Bartonella spp. infection 88, 89, 90 Urinary tract fungal infection 27
Bordetella bronchiseptica 11
Botulism 81
Brucellosis 82, 83, 84, 180 Parasitic infections
Discospondylitis 139, 140 Angiostrongylus infection 51, 52, 53,
Ehrlichiosis 95, 96, 97, 154, 155, 156, 75, 76, 77, 101, 102
170, 171, 183, 199 Babesia canis infection 99, 100, 190,
Endocarditis 124, 125, 126, 136, 137 191, 198
Gastrointestinal bacterial infections 6, Babesia gibsoni infection 30, 31
7, 8, 28, 29, 46, 47, 48, 85, 86, 87, Echinococcosis 151, 152, 153
142, 143, 144 Gastrointestinal parasitic infections
Leptospirosis 1, 2, 14, 15, 129, 186, 193 35, 36, 159
Lyme disease 172, 192 Heartworm disease 32, 33, 34, 59, 60,
Mycoplasma cynos infection 40, 41 61, 103, 104
Other mycobacterial infections 106, 107 Hepatozoonosis 9, 10, 114, 115, 116
Other rickettsial infections 141 Leishmaniosis 72, 73, 74, 91, 92, 108,
Sepsis 42 109, 123, 170, 171, 185, 187, 189
Skin bacterial infections 20, 21, 162, Neosporosis 58
163, 164, 195 Oslerus osleri infection 176, 177
Tetanus 22, 23, 24, 145, 146 Rangeliosis 133, 134, 135
Tuberculosis 120 Skin parasitic infections 3, 78, 79, 80,
Urinary tract bacterial infection 38, 148, 149, 184
62, 63 Toxoplasmosis 194
Fungal/algal infections Vaccination

Algal infections 127, 128 Anaphylactic shock after
Aspergillosis 54, 70, 71, 105, 160, vaccination 200
161, 197 Angioedema after vaccination 188
Blastomycosis 49, 50, 65, 66, 147 Assessment of vaccination and
Coccidioidomycosis 157, 158 parvovirus antibody testing 196
xv
Viral infections Influenza virus infection 178
Aujeszky’s disease 165, 166 Mumps 43, 44
Canine herpesvirus infection 37 Papilloma virus infection 45, 55, 56, 57
Canine infectious respiratory disease Parvovirus infection 93, 94, 130,
(viral agents) 150 131, 132
Coronavirus infection 169 Rabies 98, 173
Distemper 64, 138 Tick-borne encephalitis 201
Infectious canine hepatitis 68, 69,
174, 175
xvi
Questions
CASE 1 An 8-year-old female intact 1
Siberian Husky from Bern, Switzerland,
was evaluated for acute onset of
vomiting, lethargy, and increased
thirst and urination. On physical
examination, the dog was estimated to
be 7–8% dehydrated and had a tense
abdomen on palpation. The kidneys
appeared to be slightly enlarged on
palpation and a large bladder was noted.
The BCS was 5/9 (1). A CBC, serum
biochemistry panel, and urinalysis were
performed:
Complete blood count Results Reference interval

Hematocrit 0.32 l/l 0.42–0.55
Platelets 75 × 109/l 130–394
White blood cells 6.1 × 109/l 4.7–11.3
Biochemistry panel Results Reference interval

Creatinine 364 μmol/l 50–119
Urea 39 μmol/l 3.8–9.4
Glucose 4.8 mmol/l 4.1–5.9
Sodium 153 mmol/l 152–159
Potassium 4.5 mmol/l 4.3–5.3
Phosphorus 2.19 mmol/l 1–1.6
Urinalysis Results
Collection method Cystocentesis
Color, appearance Yellow, clear
Specific gravity 1.022
pH 6.8
Protein Negative
Glucose ++
Sediment Inactive
1 How would you interpret the findings in this dog?

2 What are the differential diagnoses for this dog?
1
Questions
CASE 2 Case 2 is the same dog as case 1. On abdominal ultrasound, the kidneys
were slightly enlarged and a small amount of perirenal fluid was visualized (2).
Leptospirosis is suspected as the underlying disease.
1 How would you make a specific diagnosis of leptospirosis?

2 How would you treat this dog?
3 Is there a risk of human infection when handling the dog?
3 CASE 3 A 6-month-old intact male

Labrador mix was evaluated for a 4-week
history of facial skin disease (3). The
dog was bright and alert, but showed
prominent erythema, crusting, and alopecia
periocularly as well as on the muzzle. The
dog lived in Munich, Germany, had no travel
history outside the country, was vaccinated
with core vaccines and last treated with an
endoparasiticide 6 weeks previously, and
was fed a commercial puppy food. Besides
the skin changes, the dog was unremarkable
on physical examination.
1 W
hat are the most likely differential
diagnoses for this dog based on your
assessment of the history and image
provided?
2 What diagnostic tests should be done immediately?
3 Could this dog have a transmissible infectious disease?
2
Questions
CASE 4 A 3-year-old neutered male 4
Border Collie was referred for skin lesions
on his extremities that had been present
for 4 months. Therapy with antibacterial
drugs for the past month had not been
effective. The dog appeared otherwise
healthy. The owners owned farmland
in Greensboro, Georgia, USA, and lived
by a lake. The dog spent time inside and
outside. There was no travel history. The
dog had been regularly vaccinated and
treated with parasiticides.
Physical examination, beside the skin lesions, was unremarkable. There were
draining ulcerative skin lesions on the dog’s extremities (4).
1 What are the differential diagnoses for draining skin lesions?

2 What diagnostic plan should be considered for the skin lesions?
CASE 5 Case 5 is the same dog as case 4. Serum biochemical abnormalities included
increased serum globulin concentration and serum alkaline phosphatase activity.
Cytologic findings were a predominance of neutrophils and a few macrophages. Poorly
stained, slightly basophilic thin-walled,
rarely septate hyphae were observed (5). 5
Hematoxylin and eosin-stained skin
biopsy specimens showed diffuse infiltrates
of lymphocytes, plasma cells, neutrophils,
and macrophages, and a few giant cells.
Necrotic cellular debris was interspersed
with multifocal fibroplasia. Within
the sections were thin-walled, rarely
branching hyphae with occasional septa
with bulbous enlargements. Gomori’s
methenamine silver stain highlighted the
fungal hyphal elements within the lesions.
Organisms grew on Sabouraud dextrose
agar at 25°C. Colonies were smooth and
yellow with radial folds. Smooth, thick-walled zygospores had copulatory beaks.
The organisms were identified as Basiobolus ranarum. Fungal susceptibility testing
suggested susceptibility to terbinafine, trimethoprim/sulfonamide, and amphotericin B.
1 What is the source of the organism isolated in this infection?
2 What treatment is indicated?
3
Questions
CASE 6 A 2-year-old intact male German Shepherd Dog mix was referred for
a 4-day history of acute vomiting and anorexia. Two days before the dog was
evaluated, the referring veterinarian reported icterus and had treated the dog with
oral antibiotics (doxycycline) and a single injection of a short-acting glucocorticoid.
Because the vomiting persisted, the owner did not administer the doxycycline. No
previous health problems were known. The dog was up to date on vaccinations and
regularly treated for endoparasites. He lived in a suburban area close to Munich,
Germany, and had traveled to Southern Italy once, 10 months ago.
On presentation, the dog was lethargic, but still responsive and ambulatory.
He was in a good body condition (BCS 4.5/9). Rectal body temperature was
39.8°C (103.6°F), pulse was 120 bpm, and respiratory rate was 32 breaths/min.
Mucous membranes were icteric (6). On palpation, the abdomen was tense, but
not painful. The remainder of the physical examination was unremarkable.
1 What is the differential diagnosis for icterus?

2 What non-invasive tests would you perform first to investigate this problem?
CASE 7 Case 7 is the same dog as case 6. A CBC revealed a hematocrit of

0.65 l/l (RI 0.35–0.58 l/l), a neutrophil count of 26.1 × 109/l (RI 5–16 × 109/l),
and a band neutrophil count of 5.6 × 109/l (RI 0–0.5 × 109/l).
On abdominal ultrasound examination, the liver was of normal size and
echogenicity. The gallbladder was not enlarged. No abnormal contents, such as
stones, could be visualized in the gallbladder, and the wall was not thickened (7a).
However, the common bile duct was distended and 1 cm in diameter (7b). Because
of gas in the gastrointestinal tract, the enlarged bile duct could not be followed to
its duodenal entrance.
4
Questions
7a 7b
1 What form of icterus can be ruled out based on the results of the CBC?
2 What is your assessment of the neutrophilia observed in this dog?
3 What are reasons for distension of the common bile duct?
4 Which reason is more likely in this case, and what test would you perform to
confirm your suspicion?
CASE 8 Case 8 is the same dog as cases 6 and 7. Cytologic examination of the
aspirated bile showed neutrophilic inflammation and the presence of bacteria (8a).
On bile culture, significant growth of Escherichia coli was noted.
8a
1 What are the most common bacterial species involved in bacterial cholangitis and,
therefore, what antimicrobial would you choose empirically while the results of
culture and susceptibility are pending?
2 Are bacterial infections of the hepatobiliary system common in dogs?
3 What predisposing factors contribute to ascending bacterial cholangitis?
4 For how long would you continue antimicrobial treatment?
5
Questions
9 CASE 9 A 4-year-old intact female

mixed-breed dog that lived in a rural
community in the area of Porto Alegre,
Brazil, was evaluated for anorexia,
lethargy, and weight loss over the past
4 days. The dog had been properly
vaccinated and recently treated for
parasites. On physical examination,
the dog had pale mucous membranes
with ecchymosis (9), fever (39.7°C
[103.5°F]), mild peripheral generalized
lymphadenomegaly, and splenomegaly.
Ticks found on the dog were identified as Rhipicephalus sanguineus. Significant
findings on a CBC, serum biochemistry panel, and urinalysis are shown below.
The anemia was normocytic and hypochromic.

Reticulocytes 0 × 109/l 0–60
Platelets 3 × 109/l 150–500
White blood cells 108.7 × 109/l 5–16
Mature neutrophils 103.6 × 109/l 3–9

Total protein 84 g/l 56–78
Albumin 22 g/l 31–43
Globulins 62 g/l 24–35
1 Which infectious agents can be transmitted by Rhipicephalus sanguineus?

2 What are the two most striking abnormalities in the CBC, and which tick-borne
diseases can cause these abnormalities?
3 What tests should be performed to diagnose these infections?
CASE 10 Case 10 is the same dog as case 9. A blood smear showed Hepatozoon
organisms within neutrophils (10a, 10b). PCR confirmed infection with both
Hepatozoon canis and Ehrlichia canis.
6
Questions
10a 10b
1 Which clinical signs and laboratory abnormalities in this dog are caused by
Hepatozoon canis and which are more likely to be caused by Ehrlichia canis?
2 What are the differences between the mode of transmission of Hepatozoon
canis and Ehrlichia canis?
3 What treatments are indicated for the two infections?
CASE 11 A 10-month-old neutered 11

female Labrador Retriever living in a rural
area in the region of Regensburg, Germany,
was evaluated for a 7-day history of cough.
For the 2 days before evaluation the dog
was lethargic and anorexic. The dog had
been vaccinated against distemper virus,
adenovirus, parvovirus, Leptospira spp.
infection, and rabies as a puppy and was
treated every 3 months with a parasiticide.
The owner reported that several dogs
in a puppy class that the dog attended
were also coughing. On physical examination pyrexia was noted (39.8°C [103.6°F]).
A moist cough could be elicited on palpation of the trachea. Increased lung sounds
were noted on auscultation. Thoracic radiographs revealed a mild bronchointerstitial
lung pattern. A CBC showed a neutrophilia with a mild left shift. Bronchoalveolar
lavage was performed, and the fluid was examined cytologically (11).
1 What is your assessment of this case, and how would you proceed?
2 How would you interpret the cytology of bronchoalveolar lavage fluid in this
patient?
3 What treatment would you recommend?
7
Questions
CASE 12 A 3-year-old neutered female Labrador Retriever was evaluated for
seizures. For the past week, she had shown signs of lethargy, trembling, and
circling, and she had occasionally been found with her head pressed against the
wall. She also had decreased appetite. On the day of evaluation, she had begun to
show focal seizures that were described
12 as side-to-side head movements. There
had been no cough, sneezing, vomiting,
or diarrhea. The dog lived in Shasta
Lake, California, USA. There was
no history of travel. Her owners had
started digging up their garden 4 weeks
ago. There had been no history of toxin
exposure. The dog was treated regularly
with flea and heartworm preventives
and was up to date on vaccinations
(distemper, canine infectious hepatitis,
parvovirus infection, and leptospirosis).
She was receiving no other medications.
On physical examination, she was
quiet, alert, responsive, and well hydrated. Body weight was 20 kg. The rectal body
temperature was 38.8°C (101.8°F), pulse rate was 104 bpm, and she was panting.
The remainder of the general physical examination was unremarkable. Neurologic
examination showed mild obtundation, an absent menace response on the right
side, and pain on lumbosacral palpation. Hopping was equivocally delayed in the
pelvic and thoracic limbs. Funduscopic examination showed multifocal, indistinct
gray opacities in the right eye (12).
1 What is the neuroanatomic localization of the problem?

2 What are your differential diagnoses for this dog’s problem, and what infectious
agents might be involved?
3 What is your plan for further work-up of this dog’s problem?
CASE 13 Case 13 is the same dog as case 12. The CBC and urinalysis were
normal. The biochemistry panel showed mild hyperglobulinemia (38 g/l,
RI 17–35 g/l). Thoracic radiographs were normal, whereas lumbosacral
spinal radiographs showed narrowing of the L4–L5 intervertebral disc space
with a mineralized disc at the L1–L2 space. Abdominal ultrasound revealed
enlarged mesenteric, ileocolic, hepatic, and pancreaticoduodenal lymph nodes,
which were heterogeneous in echogenicity (13a). The surrounding mesentery
8
Questions
was hyperechoic. There was segmental 13a
eccentric thickening of the muscularis
throughout the jejunum. The wall
layering in those regions was well
defined.
Aspirates of multiple lymph
nodes were obtained and revealed
changes consistent with immune
reactivity. MRI showed numerous, T1
hypointense, T2 hypo- to isointense,
contrast-enhancing nodules distrib 13b
uted throughout the cerebral
cortex, and within the thalamus
and cerebellum. There was a lobular
mass involving the olfactory bulbs
bilaterally with regional meningeal
enhancement. This lesion abutted the
cribriform plate but no mass lesion
was identified in the nasal cavity.
There were numerous cerebral nodules
throughout all lobes, the largest of
which was in the left temporal region,
measuring 1 cm. There were two large nodules in the left thalamic region, measuring
1.2 cm in diameter. These nodules resulted in mass effect with displacement of
the interthalamic adhesion to the right (13b). There were multiple nodules in
the cerebellum; the largest one was left sided and measured 0.6 cm. There was
diffuse meningeal contrast enhancement including leptomeningeal enhancement.
Moderate FLAIR hyperintensity was observed within the white matter around
the described nodules and adjacent to the lateral ventricles and mesencephalic
aqueduct.
Analysis of the CSF revealed a protein concentration of 1.07 g/l. There were
91 nucleated cells/μl, consisting of 37% neutrophils, 30% small mononuclear cells,
and 33% large mononuclear cells. No infectious agents were seen, but culture
of the CSF yielded Cryptococcus neoformans. A Cryptococcus antigen titer was
1:1024.
1 What species of Cryptococcus cause infections in dogs, and are there differences
in their ecologic niches and clinical presentations?
2 What is the recommended treatment for this dog?
3 What are possible adverse effects of drug therapy and how should response to
treatment be monitored?
9
Questions
CASE 14 An 8-month-old intact male Weimaraner (14) was evaluated for a 2-day
history of oliguria and a 3-day history of vomiting and anorexia. The dog lived
in a suburban area close to Munich, Germany, and had no travel history. He had
been vaccinated against distemper virus, canine adenovirus, and parvovirus, and
received parasite prevention once a month. On physical examination, the dog
was lethargic, appeared overhydrated, and the kidneys were slightly painful on
palpation. The remainder of the physical examination was unremarkable.
Initial laboratory examination revealed a severe neutrophilia (42 × 109 mature
neutrophils/l, RI 3–115 × 109/l) with left shift (4.5 × 109 band neutrophils/l, RI
0–3 × 109/l), thrombocytopenia (65 × 109 platelets/l, RI 150–400 × 109/), increased
serum urea concentration (48 mmol/l, RI 3.8–9.4 mmol/l), increased serum creatinine
concentration (709 µmol/l , RI 45–125 µmol/l), and a urine specific gravity of 1.016.
14
1 What is the primary problem in this dog and the most likely underlying disease?
2 What additional tests would you perform?
3 What treatment would you initiate?
15 CASE 15 Case 15 is the same dog as case 14.

The dog received aggressive supportive treatment
and antimicrobials for possible leptospirosis
(15). However, after 12 hours the dog became
anuric with a heart rate of 60 bpm and a rectal
body temperature of 37.1°C (98.8°F). After 24
hours the dog also developed respiratory distress
with a respiratory rate of 64 breaths/min.
1
What should be the monitoring plan for this
dog?
2
What are the next diagnostic and therapeutic
considerations in regards to the respiratory
distress?
10
Questions
CASE 16 A 5-year-old neutered female mixed- 16
breed dog was brought to a veterinary clinic in
San Diego, California, USA, for a routine dental
cleaning procedure. The owner reported that the
dog was healthy, but 2 weeks previously she had
an episode of lethargy lasting 2–3 days, from
which she recovered spontaneously. The owner
believed that the incident was associated with
travel that had occurred over that period, rather
than illness. The dog had not traveled outside
of California, was up to date on core vaccines,
and had no history of ectoparasites, although
preventives were not used.
On physical examination, the dog was bright,
alert, and responsive, and no abnormalities
were detected. When blood was taken for
routine pre-anesthetic bloodwork, prolonged bleeding at the site of venipuncture
was noted, with subsequent development of a hematoma and ecchymoses (16). The
CBC showed a low platelet count of 65 × 109 platelets/l. All other CBC results were
within normal limits.
1 Would you proceed with the dental cleaning procedure?

2 What are the most likely differential diagnoses for the thrombocytopenia?
CASE 17 Case 17 is the same dog as case 16. Blood smears were obtained
(17a, 17b).
17a 17b
1 Describe the blood smear findings.

2 What tests could be performed to confirm the diagnosis?
3 Does this dog need specific therapy for this problem?
11
Questions
18 CASE 18 A 6-year-old intact male

Labrador Retriever was evaluated for
a 2-month history of vomiting. The
vomiting occurred two to three times
a week, contained bile or food,
and was unrelated to food intake.
There was no diarrhea. There had
been no improvement following
administration of a hypoallergenic
diet for 4 weeks. The dog lived in
Reggio Calabria, Italy, and had been regularly vaccinated and received prophylaxis
for endoparasites and ectoparasites.
On physical examination, the dog had a thin body condition (BCS 3/9).
Otherwise the physical examination was unremarkable. The results of a CBC, serum
biochemistry panel, and urinalysis were all normal. Centrifugal zinc sulfate fecal
flotation was negative. Abdominal imaging (radiographs and ultrasound) were
unremarkable. Gastroduodenoscopy was performed. The duodenum and jejunum
appeared grossly normal, while the stomach showed pathologic changes (18).
1 How would you interpret the gastroscopy picture?

2 What would be your diagnostic plan?
CASE 19 Case 19 is the same dog as case 18. Histopathology showed mucosal
edema, lymphoplasmacytic infiltrates, and fibrosis (19a). Spiral-shaped organisms
were also seen and stained positive with Warthin–Starry silver stain (19b).
19a 19b
1 How would you interpret the results?

2 How should this dog be treated?
12
Questions
CASE 20 An 11-year-old neutered female Miniature Dachshund was evaluated for a
6-week history of pruritus and dermatitis. No other abnormalities were noted by the
owner. The dog lived in Augsburg, Germany, and had occasionally traveled to northern
Italy. It had received regular vaccinations (distemper virus, adenovirus, parvovirus,
rabies, and Leptospira spp.) but had not received parasiticides for several years.
On physical examination, papules and pustules were found on the abdomen
(20). Otherwise the physical examination was unremarkable.
20
1 What are the most likely differential diagnoses for this dog?
CASE 21 Case 21 is the same dog as case 20. Skin scrapings were negative.
An impression smear cytology was obtained (21).
21
1 What questions should the owner be asked before performing further diagnostic
tests?
2 How should you proceed based on the possible responses from the owner?
13
Questions
22 CASE 22 A 4-year-old intact male mixed-

breed dog was referred for further assessment
and treatment. The dog had a history of a
split nail and swelling of the paw 2 weeks
previously. Antibiotic treatment with
amoxicillin–clavulanic acid was instituted
and the swelling improved. On the morning
of the referral, there was an onset of facial
spasms and trismus (lockjaw) (22).
The dog came from Augsburg, Germany,
and had never traveled outside the country.
He had not been vaccinated since he was a
puppy, and not received any parasiticides
within the last year.
On neurologic examination, masticatory
muscle atrophy and mild cervical pain were
noted as additional findings. Besides the neurologic changes, physical examination
was unremarkable.
1 What is the likely etiology of the clinical signs?

2 How would you describe the different clinical stages of this disease, and what is
the prognosis?
23 CASE 23 Case 23 is the same dog as case

22. Generalized tetanus was diagnosed
on the basis of typical clinical signs. Close
inspection of the paw with the split nail
revealed that there was still some swelling
evident. Therefore, a radiograph of the
paw were taken (23). Prior to taking the
radiograph, the dog was sedated in order to
minimize exacerbation of tetanus by either
excitement or pain from the procedure.
The dog was placed in a dark and
noise-protected room with instructions
for minimal handling, and ear plugs were
applied. Initial management consisted of
intravenous application of 100 units/kg
of equine tetanus antitoxin (following a
subcutaneous test dose) and intravenous
application of diphenhydramine. Thereafter,
14
Questions
treatment with metronidazole (10 mg/kg PO q8h) was instituted in order to
control the anaerobic wound infection. Methocarbamol (10 mg/kg/h) was given
as a central muscle relaxant. The dog also received intravenous fluids and hand-
feeding. However, the dog’s condition worsened during the following day and he
developed generalized spasticity with intermittent recumbency and dysphagia.
1 How would you describe the radiographic findings?

2 What are your further treatment recommendations?
CASE 24 A 3-year-old intact female Miniature Schnauzer was evaluated for

mild head tilt and ataxia (24). The owner reported an episode of conjunctivitis,
coughing, and diarrhea 2 weeks ago and a generalized seizure 3 days ago. The dog
lived in Munich, Germany, had never traveled outside the country, was current on
vaccinations, and received regular parasiticide treatment.
A general physical examination revealed a rectal body temperature of 39.1°C
(102.4°F) and mild conjunctivitis, but was otherwise unremarkable. Neurologic
examination showed vestibular and proprioceptive ataxia, head tilt to the right,
positional rotating nystagmus, no response to touch of the left nostril, and a loss of
menace response of the left eye with normal pupillary light reflexes. Proprioceptive
positioning and hopping of the left pelvic limb were delayed. There was no evidence
of pain on spinal palpation.
Laboratory examination showed a mild neutrophilia (17.0 × 109/l). Serum
chemistry and urinalysis were unremarkable.
Based on the neurologic examination, central vestibular disease was diagnosed.
Neuroanatomic localization of lesions was multifocal brainstem and forebrain.
1 Why is the presence of CNS 24

inflammation likely in this case?
2 What diagnostic tests should be
performed?
3 What are the potential diagnostic
pitfalls?
4 What treatment should be
initiated?
15
Questions
25a CASE 25 A 4-year-old neutered female

Maltese Terrier mix was evaluated
for a 4-day history of cough and loss
of appetite. The dog lived in the San
Francisco Bay area, California, USA,
and was up to date on vaccines, was
on heartworm prophylaxis, and had no
recent exposure to other dogs.
On physical examination, the dog was
estimated to be 5% dehydrated, and had
a pulse rate of 140 bpm and a respiratory
rate of 44 breaths/min. Respiratory effort
was mildly increased, and a cough was
readily induced on tracheal palpation.
Harsh bronchovesicular sounds were
evident in all lung fields. The remainder
of the physical examination was within
normal limits. Thoracic radiographs
were taken (25a, 25b).
25b
1 What is your interpretation of the radiographs?

2 What differential diagnoses are most likely in this animal?
3 What additional tests should be performed?
16
Questions
CASE 26 Case 26 is the same dog as case 25. Bronchoscopy and bronchoalveolar
lavage were performed (26a, 26b).
26a 26b
1 What findings can be seen on bronchoscopy and on cytologic examination of

the bronchoalveolar lavage fluid?
2 What additional tests should be submitted on the bronchoalveolar lavage fluid?
CASE 27 A 10-year-old neutered 27

female Cocker Spaniel from Geneva,
Switzerland, was evaluated for recurrent
urinary tract infections, which were
associated with lower urinary tract signs
of hematuria, dysuria, and stranguria.
These infections had been treated
successfully with antimicrobial drugs in
the past but, recently, treatment had not
resulted in clinical improvement. The
dog had a history of previous traumatic
urethral injury that had been treated surgically. For further diagnostic work-up,
urinalysis was performed with light microscopy of unstained urine sediment (27).
1 What can be seen in the urinary sediment?

2 How common are fungal urinary tract infections?
3 What are risk factors for this infection?
4 What treatment should be recommended?
17
Questions

mixed-breed dog, living entirely
outdoors in a rural area of Sicily, Italy,
was evaluated because of a 2-day history
of anorexia and lethargy. The dog had
been vaccinated only for rabies and was
only treated for internal parasites once
as a puppy.
On physical examination, pyrexia
(40.0°C [104.0°F]) and petechial
lesions on the gingival mucosa were
observed (28). There were no other
abnormalities.
1 What are the differential diagnoses for the petechial lesions?

2 What useful information could be obtained from a CBC?
3 Antibody testing for which infectious diseases would be indicated, and what are
the limitations of these assays for establishing a diagnosis?
CASE 29 Case 29 is the same dog as case 28. The CBC revealed a severe
thrombocytopenia, mild non-regenerative anemia, and neutropenia. On the
blood smear, morula-like cytoplasmic inclusion bodies were observed in a few
mononuclear cells (29a) and in many platelets (29b).
29a 29b
1 What is the diagnosis?

2 How should the dog be treated?
18
Questions
CASE 30 A 2-year-old neutered male American Pitbull Terrier (30) was evaluated
for lethargy that had started 6 months previously but had become progressively
worse over the last 2 months. The dog had been seen by a veterinarian 1 month
previously; a mild anemia was diagnosed that was not further evaluated. The dog
had been treated with doxycycline, but the clinical signs did not improve. The dog
lived in Atlanta, Georgia, USA. He had been adopted by his owner about 1 year
previously when the owner found the dog roaming around the streets of Atlanta.
Within that year the dog had not traveled. The dog had been vaccinated at the time
of adoption and now received monthly preventives for endo- and ectoparasites,
including heartworm.
On physical examination, the dog was quiet, but responsive. Mucous
membranes were slightly pale; capillary refill time was 2 seconds. Otherwise, the
physical examination was unremarkable.
30
1 What would be the first step to work-up the problem of pale mucous membranes?
2 What infectious disease are American Pitbull Terriers predisposed to, and what
is the likely reason for this breed predisposition?
CASE 31 Case 31 is the same dog as 31

case 30. Babesia gibsoni was detected
on a blood smear of the dog (31).
1 If no parasites can be found on a

blood smear, what would be the
diagnostic test of choice?
2 What is the recommended treatment?
19
Questions
32 CASE 32 A 7-year-old neutered male

Siberian Husky (32) was referred
because of a 3-week history of exercise
intolerance and dry cough. The dog
lived in Munich, Germany, but had
traveled in the past to several southern
European countries. He had not received
any ectoparasite control, nor was he
ever treated for internal parasites. He
had received only vaccinations against
rabies. On physical examination, pulse
quality was normal, no heart murmur
was heard, and lung auscultation
revealed harsh lung sounds during
expiration. The dog had as slightly
reduced BCS (3/9). Otherwise the
physical examination was normal. According to the owner, bloodwork performed
by the referring veterinarian had revealed moderate hypoalbuminaemia.
1 What is your initial assessment of this case, and what are your differential
diagnoses for the dog’s problems?
2 What diagnostic tests would you perform?
CASE 33 Case 33 is the same dog as 33b

case 32. Thoracic radiographs (33a, 33b),
CBC, biochemistry panel, and urinalysis
were performed. The most notable
laboratory findings were a marked
33a
20
Questions
eosinophilia (2.946 × 109/l), hypoalbuminemia (22 g/l), a urine specific gravity of
1.023 with 3+ protein and a benign sediment, and a UPCR of 5.1.
1 What is your interpretation of the radiographs?

2 What is your assessment of the laboratory findings?
CASE 34 Case 34 is the same dog as in cases 32 and 33. Echocardiography

(34a, 34b) was performed and showed a dilated right ventricle, tricuspid
regurgitation with a velocity of 4.2 m/s (70 mmHg pressure gradient), and dilated
pulmonary arteries. Pulsed wave Doppler flow in the pulmonary artery below the
pulmonic valve was 1.8 m/s.
34a
34b
1 What is your interpretation of the echocardiographic examination?

2 What further tests would you recommend?
3 What is the likely underlying pathophysiology for proteinuria in this dog?
4 What is your treatment plan?
21
Questions
CASE 35 A 7-month-old intact male Bernese Mountain Dog was evaluated for
a 1-week history of progressive small bowel diarrhea. The diarrhea was described
as malodorous and progressing from pudding-like to watery consistency. The dog
was fed a commercial diet. He had received a full basic vaccination series and was
dewormed 4 months ago. He lived in Munich, Germany, with one other dog in the
household and had never been out of the country.
On physical examination, the
35 dog was lethargic. Dehydration was
estimated at 6%. Vital signs were within
normal limits. Abdominal palpation
revealed fluid-filled bowel loops but
was otherwise unremarkable. The BCS
was 5/9. A fecal flotation was performed
(35). The owners were concerned about
possible detection of fecal parasites,
because their two young children and
an older mixed-breed dog lived in the
same household.

2 If you are not sure about the microscopic interpretation, what additional test(s)
could you perform to confirm the diagnosis?
3 Do you think there is a zoonotic risk for the owners and their children?
CASE 36 Case 36 is the same dog as case 35. A fecal SNAP Giardia antigen test
(IDEXX Laboratories) confirmed the presence of Giardia antigen (36).
36
1 What treatment is recommended?

2 Is environmental management indicated, and what recommendations should be
made to the owner?
22
Questions
CASE 37 A 4-year-old intact female Labrador Retriever was referred together
with two of her 1-week-old puppies (one female and one male) to the emergency
service. The bitch had given birth to nine puppies. The owner reported that the
birth had been uncomplicated. During the first 4 days of life, the puppies behaved
normally. On day 5, the first puppy showed signs of respiratory distress (e.g.
tachypnea, gasping for air, and hypersalivation). Other puppies developed the
same clinical signs the following day. Affected puppies died 12–24 hours after the
onset of clinical signs. Prior to presentation, seven of the puppies had already died.
The owner lived in Atlanta, Georgia,
USA, and the bitch had never been 37a
outside of the area, had received routine
vaccinations, and had been treated for
endo- and ectoparasites regularly.
Physical examination of the bitch
revealed no significant abnormalities.
The genital tract was as expected for
the post-whelping period. Both puppies
were lethargic with the male being
more severely affected (37a). They were
tachypneic, with vocalization, dyspnea,
and hypersalivation. Auscultation of
the lungs revealed diffusely increased
breath sounds.
Both puppies were euthanized.
Necropsy was performed, and findings
were similar in both puppies, but
more severe in the male pup. On
histopathology, multifocal hemorrhage, 37b
edema, and increased septal width
were found throughout the lungs.
Hemorrhage, edema, and necrosis were
also found in the liver, kidneys (37b), and
spleen. Fresh tissue specimens stained
positive for canine herpesvirus by IFA.
1 How common is canine herpesvirus

infection, and how is it transmitted?
2 What clinical signs occur after infection?
23
Questions
38 CASE 38 An 11-year-old neutered

male mixed-breed dog (38) living in
Lausanne, Switzerland, was referred
for evaluation of possible chronic
kidney disease based on the detection
of azotemia on bloodwork. The
owner reported that the dog had been
polyuric and polydipsic for several
weeks but was otherwise healthy. The
dog had been vaccinated with routine
vaccines (distemper virus, adenovirus,
parvovirus, Leptospira spp., and rabies virus) and was receiving parasiticides on
a regular basis. On physical examination, the only abnormalities detected were
several subcutaneous masses on the dog’s trunk. The results of a CBC, biochemistry
panel, and urinalysis with culture (by cystocentesis) are shown below:


Urea nitrogen 6.8 mmol/l 3.8–9.4
Urinalysis Results Reference interval

Collection method Cystocentesis –
Color, appearance Yellow, slightly turbid –
Specific gravity 1.018 1.015–1.045
pH 7.5 5.5–7
Protein Negative –
Glucose Negative –
Ketone Negative –
Bilirubin + –
Blood + –
Red blood cells 4–8 cells/hpf 0–5
White blood cells 12–20 cells/hpf 0–3
Bacteria Numerous 0
Urine culture >105 CFU/ml E. coli
susceptible to amoxicillin
24
Questions
An abdominal ultrasound revealed no abnormalities.
1 What are your primary differential diagnoses for PU/PD in this dog?
2 How would you interpret the laboratory results?
3 How common are bacterial urinary tract infections in dogs?
4 What are the most common bacterial species causing urinary tract disease in dogs?

male Cockapoo was evaluated for a
3-week history of anorexia. He had
recently developed a non-productive
hacking cough. The dog lived in Davis,
California, USA, and was employed
as a service animal for his disabled
owner and traveled on a monthly basis
to Hawaii, west Texas, and Arizona.
He was regularly vaccinated and on
monthly heartworm prophylaxis.
On physical examination, his rectal temperature was 40.1°C (104.2°F),
pulse rate was 100 bpm, and respiratory rate was 120 breaths/min. Harsh lung
sounds were auscultated bilaterally and a honking cough was elicited on tracheal
palpation. Cardiac auscultation was unremarkable. The remainder of the physical
examination was normal. A right lateral radiograph had been taken by the
veterinarian (39).
A CBC was performed:

MCV 66.1 fl 58–72
Platelets 505 × 109/l 150–500
Neutrophils 18.090 × 109/l 3–9
Eosinophils 0.555 × 109/l 0–1.0
Basophils 0.048 × 109/l 0–0.04
Lymphocytes 3.594 × 109/l 1–3.6
Monocytes 1.833 × 109/l 0.04–0.5
1 How would you interpret the CBC?

2 What imaging abnormalities are present in the radiograph?
3 What differential diagnoses should be considered?
4 What other diagnostic tests should be performed?
25
Questions
40a CASE 40 A 5-year-old intact male

Weimaraner was evaluated for a 10-day
history of cough. Two weeks prior to
evaluation, vomiting and diarrhea had
been noted but had resolved in 2 days.
The owner of the dog lived in Davis,
California, USA, and was part of a rescue
foundation and frequently admitted new
dogs to the household. She was currently
caring for six Weimaraners and all had
become sick following the last admission.
40b The other dogs had recovered after
treatment with amoxicillin and a cough
suppressant; however, this dog continued
to cough and experienced a 5 kg weight
loss. All dogs were vaccinated every
3 years with products purchased from
the local supply store. They were also
treated with endo- and ectoparasiticides
but not on a regular basis.
temperature was 39.6°C (103.3°F),
pulse 108 bpm, and respiratory rate
30 breaths/min with mild expiratory
effort. The dog repeatedly exhibited
a soft moist cough. Harsh expiratory
breath sounds were auscultated dorsally.
A CBC and thoracic radiographs (40a,
40b) were obtained.

Platelets 365 × 109/l 150–500
Band neutrophils 0.237 × 109/l 0–0.5
Eosinophils 0.474 × 109/l 0–1.0
Lymphocytes 0.711 × 109/l 1–3.6
Monocytes 2.606 × 109/l 0.04–0.5
1 How would you interpret the CBC results and radiographs?

2 Which differential diagnoses are highest on your list?
26
Questions
CASE 41 Case 41 is the same dog as 40. A bronchoscopy was performed (41a),
and bronchoalveolar lavage fluid was obtained (41b).
41a 41b
1 What tests would you recommend on this fluid?

2 What underlying diseases should be considered?

female German Shepherd Dog was
admitted to the emergency service of
the University Veterinary Teaching
Hospital in Munich, Germany,
because of lethargy and fever of
2 days’ duration. The dog had been
bright and alert in the days leading
up to this episode, but had been
bitten in the cervical area by another
German Shepherd Dog 2 weeks
previously. The dog had been seen by
a veterinarian at that time who had cleaned and closed the wound. The dog was
up to date on routine vaccinations and was regularly treated with parasiticides.
On physical examination, pulse quality was normal, but an irregular rhythm was
noted. No heart murmur was heard on auscultation of the thorax. Temperature
was elevated (40.1°C [104.2°F]). The bite wound was identified and appeared
to be healing normally. Otherwise the physical examination was unremarkable.
An ECG (42) was obtained (paper speed 50 mm/s, 1 cm = 1 mV).
1 What is your ECG diagnosis?

2 How would you treat the ECG abnormality?
27
Questions
43 CASE 43 A 3-week-old intact female Rottweiler

was evaluated because the owner noted bilateral
swelling below the ears (43) that appeared over
a period of a few hours. No other abnormalities
were reported. The puppy otherwise had normal
behavior and was suckling. The puppy had not
yet been vaccinated or treated for endoparasites.
The bitch was 3 years old and was the only adult
dog in the household. The owner explained that
the pregnancy had been an accident. The owner
and his family lived in Warsaw, Poland, and the
owner reported that his child had been diagnosed
with mumps 6 days previously.
Physical examination revealed a temperature
of 38.5°C (101.3°F). Both parotid salivary glands were significantly enlarged, firm,
but movable and non-painful on palpation. The skin over the parotid glad was
normal. The rest of the physical examination, including an oral cavity examination,
was unremarkable.
1 What is the most likely diagnosis?

2 What diagnostic tests could be considered?
3 What is the prognosis?
CASE 44 Case 44 is the same dog as case 43. Mumps is suspected in this puppy.
The rest of the litter (nine other puppies) were apparently healthy, and so was the
bitch (44).
44 1 What are the possible differential

diagnoses?
2 What treatment is needed?
3 What complications can develop
in the course of mumps in dogs?
4 Can a dog suffering from mumps
transfer this infection to humans
or other animals?
28
Questions
CASE 45 A 1-year-old neutered female French Bulldog was evaluated for multiple
“wart-like” lesions on the eyelids of its right eye, which had developed within the
last 4 weeks. The dog had become increasingly uncomfortable, with a serous ocular
discharge from this eye. The owner had also noticed cloudiness at the lateral part
of the eye. The dog lived in Atlanta, Georgia, USA, was otherwise healthy, current
on all vaccinations, and enrolled in a regular endo- and ectoparasite control
program.
Physical examination was unremarkable besides the ophthalmic changes. On
ophthalmic examination of the right eye multiple, light-brown pigmented, round,
“cauliflower-like” lesions of different sizes were located around the upper and lower
eyelids, mainly at the lateral aspect of
the eye and the adjacent conjunctiva 45
(45). The conjunctiva was diffusely
hyperemic and mildly chemotic. On slit
lamp examination, focal corneal edema
was found in the lateral quadrant of
the cornea, surrounding a deep stromal
corneal ulcer. The ulcer stained positive
with fluorescein, but a small “clear”
area remained in the center of the ulcer.
The anterior chamber had very mild
flare (positive Tyndall effect). The iris
was normal, but the pupil was rather
miotic.
Ophthalmic examination Right eye (OD) Left eye (OS)

Menace response Present Present
Dazzle reflex Present Present
Pupillary light reflex Pupil miotic Normal
Schirmer tear test 20 mm/min 15 mm/min
Intraocular pressure 10 mmHg 15 mmHg
1 What is your ocular diagnosis?

2 What diagnosis of the eyelid lesions might you suspect based on the clinical
presentation?
3 What treatment do you suggest for this dog?
29
Questions
46 CASE 46 A 5-year-old neutered female mixed-

breed dog was evaluated for acute hemorrhagic
diarrhea (46) of 12 hours’ duration. Vomiting
had started about 12 hours before the diarrhea
was observed. The diarrhea was described as
watery with a pale red color, progressing in
severity and frequency. Over the last 2 hours,
the dog had become lethargic and refused to
walk. The dog lived in Munich, Germany,
and had never been outside the country. She
was regularly vaccinated and dewormed. She
also received ectoparasite control on a regular
basis. The dog was on a raw meat diet, and
this had not been changed for at least 1 year.
Intoxication was considered unlikely by the
owner.
lethargic. Heart and respiratory rate were
140 bpm and 54 breaths/min, respectively.
The rectal body temperature was 36.7°C
(98.1°F). The dog had pale mucous
membranes and the capillary refill time was
>2 seconds. Dehydration was estimated at
10%. Abdominal palpation revealed a tense
but not obviously painful abdomen. The dog
had a BCS of 4/9 (30 kg).
1
What are the differential diagnoses for acute hemorrhagic diarrhea, and what
diagnostic tests would you perform?
2
What is the definition of hemorrhagic gastroenteritis syndrome?
3
Which dogs are predisposed to hemorrhagic gastroenteritis syndrome?
CASE 47 Case 47 is the same dog as case 46. On evaluation, the dog showed
clinical signs that were suggestive of sepsis (e.g. hypothermia, tachycardia, and
tachypnea). A blood stream infection with primary enteropathogenic bacteria was
considered possible. Therefore, a fecal culture for enteropathogenic bacteria and a
blood culture (47) were performed.
30
Questions
1 What information from the history is important 47
for interpretation of the fecal culture?
2 What bacterial species are currently considered
primary enteropathogenic bacteria?
3 Which bacterial species is believed to play
a primary role in dogs with hemorrhagic
gastroenteritis syndrome?
CASE 48 Case 48 is the same dog as cases 47 and 46. During the first 24 hours, a
rapid improvement of clinical signs could be observed. Fluid therapy is considered the
most important treatment. Different crystalloid and colloid fluids are available (48).
48
1 Why is fluid therapy considered life saving in this case?

2 How much fluid would you give over the first 24 hours?
3 Would you treat this dog with antibiotics?
31
Questions
CASE 49 A 5-year-old intact male Pointer mix was evaluated for bilateral
blindness and bluish-cloudy, red, and painful eyes (49a, 49b). Prior to the onset
of the ocular symptoms, the dog had been very lethargic with decreased appetite.
In addition, intermittent episodes of coughing and lameness were reported. The
dog served as an active hunting dog in Helen, Georgia, USA, but the owner often
went on hunting trips to the Mississippi and Ohio River valleys. The dog had
received regular vaccinations as well as endo- and ectoparasite control.
On physical examination, the mandibular lymph nodes were enlarged and the
dog had a rectal body temperature of 39.9°C (103.8°F). The left eye appeared
enlarged (49c). Otherwise, the physical examination was unremarkable. An
ophthalmic examination was performed.
49a 49b
49c
32
Questions

Menace response Absent Absent
Dazzle reflex Absent Absent
Pupillary light reflex Dilated Cannot assess
1 What ophthalmic findings are present?

2 What further diagnostic tests would you suggest?
CASE 50 Case 50 is the same dog as case 49. Ocular ultrasound (50a) and fine
needle aspiration of the right mandibular lymph node with cytologic examination
were performed (50b).
50a
50b

2 What treatment would you suggest?
3 What is the prognosis for vision in this dog?
33
Questions
CASE 51 A 9-year-old neutered female mixed-breed dog living in Augsburg,
Germany, was referred for a several-week history of dry cough and lethargy. The
owner also noticed exercise intolerance and a decreased activity level. A 10-day
course of treatment with enrofloxacin did not improve the clinical signs. The
dog had no travel history outside
51 northern Europe. She was up to date
on routine vaccinations; preventive
treatment for parasites was
unknown. On physical examination,
the dog was lethargic with normal
vital signs. On auscultation of the
thorax, slightly harsh lung sounds
were noted during inspiration and
expiration; the heart sounds were
normal. Cutaneous ecchymoses
were noted on the ventral and
lateral aspects of the abdomen (51).
1 What are the differential diagnoses for the problems identified?

2 What diagnostic tests would you perform?
CASE 52 Case 52 is the same dog as case 51. Thoracic radiographs (52a, 52b),
CBC, serum biochemistry analysis, urinalysis, and a coagulation profile were
performed. The CBC showed only mild eosinophilia. Serum biochemistry
52a 52b
34
Questions
analysis and urinalysis detected no abnormalities. The coagulation profile
revealed the following:
Coagulation panel Results Reference interval

PT 42 sec 16–27
aPTT 56 sec 10–13
D-dimers 1,000 ng/ml <250
1 What is your assessment of the diagnostic test results?

2 What additional diagnostic work-up would you suggest?
CASE 53 Case 53 is the same dog 53

as cases 51 and 52. Baermann fecal
examination was negative. Cytologic
examination of bronchoalveolar lavage
fluid revealed larvae of Angiostrongylus
vasorum (53).
1 What treatment would you suggest

for this dog?
2 What should you recommend to the
owner to prevent reinfection?

Golden Retriever was evaluated because
of a 2-month history of serous right-
sided nasal discharge and sneezing. He
walked and ran daily in the fields and
woods around the owner’s house. The
dog lives in Davis, California, USA. The
dog was up to date on core vaccinations
and was receiving monthly heartworm
prophylaxis. The photograph was taken
on physical evaluation (54).

2 What physical examination features
would be expected in this dog?
35
Questions
55 CASE 55 A 1.5-year-old intact male

mixed-breed dog was evaluated for wart-
like lesions in the mouth, which had
been present for at least the last 3 weeks.
The dog lived in Katowice, Poland, had
never traveled outside the country and had
received regular vaccinations (distemper
virus, adenovirus, parvovirus, and rabies
virus) and prophylactic treatment for
ectoparasites and endoparasites.
On physical examination, the dog
was bright and alert and in good body
condition. The only abnormalities noted
were multiple, variably sized, firm,
white–gray cauliflower-like lesions on lips, buccal mucosa, palate, tongue, gingiva,
and mucocutaneous junctions around the mouth (55).

2 Are there other differential diagnoses?
3 How can the diagnosis be confirmed?
CASE 56 Case 56 is the same dog as case 55. Canine oral papillomatosis was
diagnosed, based on the appearance of the lesions (56).
56

3 Can dogs be vaccinated against oral papillomatosis?
36
Questions
as cases 55 and 56. Laser surgery was
performed to remove prominent warts
(57).
1 Can this dog spread the disease to

other dogs?
2 Are other animals and humans at
risk of becoming infected?
CASE 58 A 5-year-old intact male 58

Rhodesian Ridgeback was evaluated for
non-ambulatory tetraparesis, reduced
mentation, and a mild head tilt to the
right (58). Further questioning of the
owner revealed a 3-month history
of chronic progressive ataxia with
hypermetria. Sudden worsening of the
dog’s clinical condition occurred 1 week
after treatment with prednisolone
(1 mg/kg/day) was initiated.
The dog came from Munich,
Germany, had never traveled outside
the country, and had received regular
vaccinations. He had not received any antiparasitic treatment within the last
2 years.
On neurologic examination, masticatory muscle atrophy and mild cervical pain
were noted as additional findings. Besides the neurologic changes, the physical
examination was unremarkable.
Further work-up with MRI and cerebrospinal fluid examination showed
cerebellar atrophy and a lymphohistiocytic CSF pleocytosis.
1 What further diagnostic tests should be performed?

2 What treatment should be started while results of diagnostic tests are pending?
3 Why might glucocorticoids be contraindicated for treatment of this disease?
37
Questions
CASE 59 A 6-year-old neutered male Pug was evaluated for labored breathing,
cough, lethargy, anorexia, and pale mucous membranes. These signs had progressed
over the previous 2 weeks (59). No ocular or nasal discharge, cough, sneezing,
polyuria, or polydipsia was present. Urination was normal. The dog had no
significant past medical history. The dog lived indoors only and currently lived in
Montreal, Canada, but traveled with his
59 owners every summer to the Gulf coast
of the United States. The dog was up
to date on vaccinations. The clients did
not use any preventive treatments for
parasites because the dog did not have
outdoor access.
Physical examination revealed a
temperature of 38.3°C (100.9°F),
increased bronchovesicular lung sounds
in the caudodorsal region of the thorax,
tachypnea with a deep labored breathing
pattern, pale mucous membranes, a
grade III/VI right apical systolic murmur,
and an irregular cardiac rhythm with
pulse deficits.
1 How would you initially manage this case?

2 The client is concerned about costs; therefore, what diagnostic tests would you
perform?
3 What are the primary differential diagnoses for the problems?
CASE 60 Case 60 is the same dog as case 59. Lateral and ventrodorsal thoracic
radiographs were obtained (60a, 60b).
60a 60b
38
Questions
1 Describe the thoracic radiographic findings.
2 How do these findings affect the differential diagnoses list in this case?
3 What is your diagnostic plan?
CASE 61 Case 61 is the same dog as cases 59 and 60. The ECG indicated a
sinus tachycardia (156 bpm) with atrial premature complexes and right-shift
deviation of the mean electrical
axis, suggestive of right ventricular 61a
hypertrophy and atrial disease.
An echocardiogram showed severe
thickening of the right ventricle,
with concentric hypertrophy
and mild dilation. Pulmonic and
tricuspid valvular regurgitation
was identified. The right ventricular
systolic pressure was estimated
via Doppler interrogation of the
pulmonic regurgitation gradient
as approximately 90 mmHg,
consistent with severe pulmonary 61b
arterial hypertension. Multiple
heartworms were present, which
moved from the right ventricle to the
right atrium during diastole (61a,
white arrow). An in-clinic ELISA
test was positive for Dirofilaria
immitis antigen. Microfilariae were
detected in blood smears (61b).
Diagnosis of heartworm disease
was confirmed.
1 What are other important

consequences of infection with this parasite?
2 How would you classify the stage of heartworm disease in this case?
39
Questions
CASE 62 A 9-year-old neutered female mixed-breed dog from Zurich, Switzerland,
was evaluated for a second opinion regarding recurrent cystolithiasis. Over the last
2 years, stones had been surgically removed three times. On abdominal radiography
before the first surgery, bladder stones were visible (62). Aerobic bacterial urine
culture prior to the first surgery was negative. No further urine cultures were
performed. Although the dog is currently clinically normal, the owner wanted to
make sure that the stones did not recur. Physical examination was unremarkable.
62
1 What is the most common composition of uroliths in dogs?

2 What further tests would you recommend in this dog?
CASE 63 Case 63 is the same dog as case 62 (63). For further diagnostic work-up,
cystocentesis was performed for urinalysis including urine culture:
63 Urinalysis Results
Color, appearance Light yellow, medium
pH 6.0
Protein +
Glucose Negative
Ketone Negative
Bilirubin +
Blood ++
Protein to creatinine 0.19
ratio
Red blood cells 8–12 cells/hpf
White blood cells Too numerous to
count
Bacteria Many cocci
Urine culture Large numbers of
coagulase-negative
Staphylococcus spp.
40
Questions
Abdominal radiographs and ultrasound showed no evidence of cystoliths.
1 Considering the results of the urinalysis, how would you treat this dog?
2 What methods of stone removal other than surgical cystotomy after laparotomy
would be possible in this dog?
3 The dog was stone free but bacteriuria was present. What is the difference
between bacteriuria and urinary tract infection? List possible reasons for
recurrent urinary tract infections in dogs.
CASE 64 A 2-year-old intact male German Shepherd Dog was evaluated for
a 2-day history of inappetence and stiff gait, followed by rapidly progressive
muscular rigidity and several generalized seizures. A week before the onset of
these signs, the owner had taken the dog to another veterinary clinic for a 3-day
history of mild lameness. The owner had also noticed a small amount of blood on
the left front footpad just before the onset of lameness. Rest was recommended,
and the lameness disappeared. The dog lived in a rural area outside Warsaw,
Poland, with two other adult dogs and a litter of puppies. The dog had never
been vaccinated or treated for parasites. On admission, lateral recumbency and
extensor rigidity were present (64). The dog was hypersensitive to external stimuli,
which resulted in tonic convulsions with opisthotonus, trismus, contraction of the
facial musculature (risus sardonicus), enophthalmos with prolapse of the third
eyelid, and erect ears. Severe respiratory dysfunction (periods of apnea followed
by gasping) and hyperthermia were present. Generalized tetanus was diagnosed,
based on the history and clinical signs.
64
1 What is the risk of infection to other animals and humans?

2 Should dogs be vaccinated to prevent tetanus?
3 How can tetanus be prevented in dogs?
41
Questions
65a CASE 65 A 2-year-old neutered male

Golden Retriever was evaluated because
of lethargy and anorexia of 1 week’s
duration. He lived in the Sierra Nevada
Mountains of northern California,
USA, and had recently traveled to
Ontario in Canada, Vermont in the
northeastern USA, and Carmel on the
coast of northern California. The dog
was up to date on vaccinations and was
on heartworm prophylaxis.
65b temperature was 39.1°C (102.4°F),
pulse 120–160 bpm, and the dog panted
continually. The dog demonstrated
marked flaring of the nostrils during
respiration, and open-mouth breathing.
Harsh breath sounds heard bilaterally
over the thorax obscured the heart
sounds, but no pulse deficits were
detected. A dry cough was elicited on
tracheal palpation. With minor exertion,
marked respiratory difficulty with
cyanosis was noted. The remainder of the
Thoracic radiographs were obtained
(65a, 65b).
1
What is your interpretation of the
thoracic radiographs?
2
What differential diagnoses should
be considered?
3
What diagnostic tests should be
performed?
CASE 66 Case 66 is the same dog as case 65. Tracheal wash fluid cytology
showed a marked pyogranulomatous inflammation and yeast structures that
were 15–30 μm in diameter, consistent with infection by the dimorphic fungus
Blastomyces spp. (66).
42
Questions
1 Given the tissue tropism of this 66
organism, what other examinations
might be indicated?
2 What treatment options should be
considered?
CASE 67 A 2-year-old neutered female Pug was evaluated for skin lesions in the
region of the right carpus. Erythema, scaling, alopecia, and crusting were present
(67). The dog was bright and alert and not very pruritic. It was regularly vaccinated
and treated for endoparasites. The dog lived in Ausgburg, Germany, and had never
been outside the country.
Physical examination revealed no abnormalities besides the skin lesions
described. Skin scrapings were negative. An impression smear was made, stained
with a modified Wright’s stain, and revealed numerous macrophages and some
neutrophils with only a few extracellular bacteria.
67
1 What is your most likely diagnosis?

2 What further tests are indicated in this dog?
3 How would you treat this dog based on your most likely diagnosis?
43
Questions
68 CASE 68 A 6-month-old intact male

mixed-breed stray puppy was presented
to the University Veterinary Teaching
Hospital in Messina, Italy, with severe
acute diarrhea and vomiting a few
days after he was rescued by an animal
shelter. No previous history was
available.
On physical examination, abnormal
findings included pale mucous
membranes, prolonged capillary refill
time (3 sec), 7–8% dehydration, pain
on abdominal palpation, and increased
temperature (40.1°C [104.2°F]). A fecal
parvovirus in-house antigen test was positive and CBC revealed a lymphopenia.
The dog was kept in isolation and received intensive care, including intravenous
fluids, antiemetics, and a parenteral third-generation cephalosporin. Subsequently,
there was a progressive improvement of the dog’s clinical condition. However, on
day 6 the dog again became very lethargic and vomited. In addition, pyrexia and
ecchymotic hemorrhages on the skin and mucosal surfaces were observed (68).
1 What are your primary differential diagnoses for the new clinical presentation?
2 What diagnostic tests should be done first?
69a CASE 69 Case 69 is the same dog as

case 68. Leukopenia with lymphopenia
and neutropenia, a low platelet count,
very high ALT activity (7,423 U/l), as
well as high aPTT and D-dimers were
found on CBC, biochemistry panel,
and coagulation profile. One day
later, the dog developed hematemesis,
melena, and dark orange urine (69a).
Abdominal and thoracic radiographs
were unremarkable.
1 What is the most likely diagnosis in this puppy?

2 What tests could be performed to confirm the diagnosis?
3 Why are confirmatory tests necessary?
4 What is the prognosis for this dog?
44
Questions
CASE 70 A 3-year-old intact male Doberman 70
Pinscher from Munich, Germany, was evaluated
for a 6-month history of mucopurulent nasal
discharge (70), mainly on the right side. The
dog was regularly vaccinated and treated
with intestinal parasite preventives. Except
for the nasal discharge, the owner did not
report any other problems; the dog was bright,
alert, and eating well. The dog had received
several courses of antimicrobials (including
first amoxicillin, later enrofloxacin). During
antimicrobial treatment, the nasal discharge
improved only slightly. A sample of the nasal discharge had been submitted for
bacterial culture and susceptibility testing and yielded Pasteurella multocida. The
isolate was susceptible to all tested antibiotics. Physical examination revealed
purulent right-sided nasal discharge and a slightly enlarged right mandibular lymph
node. Otherwise the physical examination was unremarkable.
1 What differential diagnoses should be considered for nasal discharge in this patient?
2 Why did the patient not respond to antimicrobial treatment?
3 How would you proceed to work-up the case?
CASE 71 Case 71 is the same dog as case 70. 71a

A diagnostic work-up was performed as
described. A CBC and serum biochemistry
were unremarkable, and coagulation times
were normal. CT revealed severe destruction of
the turbinates in the right nasal cavity, moderate
destruction on the left side, and thickening of
the frontal and maxillary bones. The frontal
sinuses were filled with abnormal soft tissue
on both sides. The cribriform plate was intact.
On rhinoscopy with a rigid endoscope (71a),
white fungal plaques could be visualized on the
mucosal surfaces, and there was destruction of
the turbinates bilaterally. The right frontal sinus could be accessed with a flexible
endoscope and fungal plaques could be visualized in this area as well. Several biopsies
were taken of the plaques and submitted for histopathology and fungal culture.
1 What is your diagnosis?

2 What do you recommend for treatment in this case?
45
Questions
72 CASE 72 A 6-year-old male Labrador

Retriever from Bristol, UK, that had lived
in Spain in recent years before returning
to the UK 6 months ago was evaluated
for a skin problem that included alopecia,
crusts, scaling, and hyperpigmentation
around the face, ears, limbs, and dorsum
(72). Over the last 2 months, the dog
had developed progressive inappetence,
lethargy, polydipsia, and weight loss.
The dog had regularly received core
vaccines (distemper virus, adenovirus,
parvovirus, rabies virus, and Leptospira
spp.) and was treated regularly for
intestinal parasites.
Physical examination revealed a thin body condition (BCS 2–3/9), mucoid

ocular discharge, generalized peripheral lymphadenomegaly, splenomegaly, mild
pyrexia, and pale mucous membranes. A CBC, biochemistry panel, and urinalysis
were performed.

Platelets 50 × 109/l 150–500

Total protein 95 g/l 55.5–77.6
Albumin 21 g/l 31.3–43
Globulin 74 g/l 24.2–34.6
Calcium 2.55 mmol/l 2.2–2.8
Urinalysis revealed a specific gravity of 1.015, with 3+ protein and a benign

sediment. The UPCR was 1.5 (RI <1.5).
1 What are the most likely differential diagnoses in this dog?

2 What diagnostic tests should be done next?
46
Questions
CASE 73 Case 73 is the same as case 72. Serum was submitted for Leishmania
spp. antibody detection. Cytologic examination of a fine needle aspirate of the
right popliteal lymph node (73) was performed.
73
1 Describe the cytologic findings in the lymph node aspirate.

2 What factors can influence the results of Leishmania spp. antibody tests?
CASE 74 Case 74 is the same as cases 72 and 73. An indirect fluorescent antibody
test revealed a high antibody titer to Leishmania spp. (74). The clinical stage of the
patient was classified as grade III (severe disease).
74
1 What are the treatment options, and what is the prognosis for this dog?
2 The owner has two other dogs and three young children. What actions are
indicated to prevent human infection in this situation?
47
Questions

Pug (75) was referred for evaluation of
a 6-week history of cough, respiratory
difficulty, and exercise intolerance. The
referring veterinarian had previously
performed echocardiography and had
suspected right ventricular hypertrophy.
The dog was up to date on vaccinations
(distemper virus, adenovirus,
parvovirus, rabies virus, and Leptospira
spp.), but had not been treated with
parasiticides within the last 2 years.
The dog lived in Munich, Germany, and
had never left the country. On physical
examination, the dog was in respiratory distress, lung sounds were harsh on
thoracic auscultation, especially during expiration, and the respiratory rate was
80 breaths/min. No cardiac murmur was heard. The heart rate was 160 bpm, but
pulses were strong and synchronous. The mucous membranes were pink with a
normal capillary refill time. Physical examination otherwise was unremarkable.
1 What is your first assessment of this dog’s problems?

2 What diagnostic steps should you perform next?
CASE 76 Case 76 is the same dog as case 75. Thoracic radiographs were performed
(76a, 76b) and echocardiography was repeated. Color-flow Doppler showed no
evidence of aortic, tricuspid, pulmonic, or mitral valve insufficiency. Figure 76c
76a 76b
48
Questions
shows a right parasternal long axis view; figure 76d shows a short axis view with left
atrium, aorta, and pulmonary artery.
76c 76d
1 What is your assessment of the radiographic findings, and what is the differential
diagnosis?
2 What is your assessment of the echocardiographic study?
CASE 77 Case 77 is the same dog as cases 75 and 76 (77). The owners agreed to
a further work-up. The echocardiographic study raised suspicion for pulmonary
hypertension.
77
1 How can pulmonary hypertension be confirmed by echocardiography?

2 What other tests are available to identify pulmonary hypertension?
3 What are the main differential diagnoses for pulmonary hypertension?
4 What further tests do you recommend?
49
Questions

Old English Sheepdog was evaluated for
a 6-month history of skin disease that
initially started with hypotrichosis and
then gradually deteriorated. The dog
had generalized skin lesions (papules,
pustules, crusts, and alopecia) that
were most pronounced on the abdomen
(78) and limbs. An injection with
glucocorticoids did not seem to alleviate
the clinical signs. A 2-week course of
cephalexin at 25 mg/kg PO q12h improved the clinical signs, but did not lead to
remission. In the last month, pruritus had become a more prominent feature, and
over the last 2 weeks the dog had become lethargic and showed a reduced appetite.
The dog came from Munich, Germany, had never traveled outside the country, and
had received regular vaccinations. It had not received any antiparasitic treatment
within the last 2 years.
Besides the skin changes, the physical examination was unremarkable.
1 What are the three most likely differential diagnoses for this dog, based on your
review of the image provided?
CASE 79 Case 79 is the same dog as case 78. Cytology (79a) and deep skin
scrapings (79b) were performed.
79a 79b
1 What questions need to be asked to guide your further diagnostic testing?

2 If there are no additional clues in the history, what other diagnostic tests should
be considered for this patient?
50
Questions
CASE 80 Case 80 is the same dog as cases 80
78 and 79. The dog had low thyroxine
concentrations (3 nmol/l, RI 11–
60 nmol/l) and high TSH concentrations
(8.2 pg/ml, RI <5 pg/ml), supporting a
diagnosis of underlying hypothyroidism.
Levothyroxine (20 µg/kg PO q12h) was
prescribed (80).
1 How would you treat the dog’s

demodicosis?
2 How would you monitor and adjust
the thyroid hormone supplementation?

Kuvasz was evaluated for acute onset
of lateral recumbency. The day before
evaluation, the dog had been lethargic
but otherwise normal. The dog
belonged to a group of three dogs that
had consumed a dead animal carcass
3 days ago. The other two dogs also
showed signs of paresis, although less
severe. There was no trauma or relevant
previous illness in any of the dogs. All
the dogs were up to date on vaccinations, and tick and flea preventives were used
regularly. The three dogs came from Ingolstadt, Germany, and none of them had
traveled outside of the country.
General physical examination was unremarkable apart from lateral recumbency.
Neurologic examination revealed inability to lift the head or move the limbs. Spinal
reflexes (patellar reflexes, flexor withdrawal reflexes) were absent in all limbs (81).
The dog was responsive to pain stimuli as assessed by eye movements and his
ability to wag the tail. Cranial nerve examination showed slightly mydriatic pupils
with a decreased pupillary light reflex, but was otherwise unremarkable. Fundic
examination was unremarkable. Neuroanatomic localization in this dog was a
generalized lower motor neuron disorder.
1 What are your differential diagnoses in this dog?

2 What are the next diagnostic steps?
51
Questions
CASE 82 A 2-year-old neutered female mixed-breed dog was evaluated for
lethargy and difficulty in walking. The dog had trouble rising from recumbency
over the last 2 months. Occasionally, she scuffed the left pelvic limb while walking.
Over the last 5 days, she had become paraplegic. The dog was still eating and
drinking normally. The dog was picked up as a stray and admitted to a shelter
about 1.5 years previously. She was neutered during her residency at that shelter.
The dog had been obtained from the shelter by the owners about 1 year previously.
The dog now lived in Atlanta, Georgia, USA, and had no travel history within
the last year. The dog was currently
82 vaccinated and received parasiticides
on a regular basis.
On physical examination, mild
lymphadenomegaly was evident in
the palpable superficial lymph nodes.
The dog was dragging her pelvic limbs
(82). She had an arched back, and
paraspinal hyperesthesia was evident
during muscle palpation of the dorsal
mid-lumbar region. When her weight
was supported, proprioceptive deficits
were evident bilaterally and were most
severe in the left pelvic limb. Myotatic
reflexes were normal to increased in
both limbs. Miosis was present in the
right eye and aqueous flare was seen in
the anterior chamber.
1 What would be the next diagnostic steps to further work-up the dog’s major
problems?
2 What are the differential diagnoses for generalized lymphadenomegaly, and
what is the first step in a diagnostic work-up?
3 What disease processes can be associated with miosis and aqueous flare?
CASE 83 Case 83 is the same dog as case 82. A complete neurologic examination
confirmed postural reaction deficits (hopping, conscious proprioception,
extensor postural thrust) in the pelvic limbs, which were worse on the left side.
Flexor and myotatic reflexes were present in both pelvic limbs, with slightly
increased reflex responses noted in the left limb. Ophthalmic examination
showed fundic abnormalities including aqueous flare and hyphema in the
52
Questions
right eye. Retinal lesions were found 83
in the ocular fundus of this eye
indicative of chorioretinitis.
The CBC was unremarkable. In the
biochemistry profile, hyperproteinemia
with hyperglobulinemia was present
(total protein 88.6 g/l, albumin 36.3 g/l,
globulin 52.3 g/l). A serum protein
electrophoresis was performed (83).
1 What is the site of neurologic

localization, and what further tests
would be indicated?
2 What infectious diseases of dogs can be associated with inflammation in the
anterior and posterior eye segments?
3 What further diagnostic tests would you suggest to confirm one of these
infections?
4 What does electrophoresis suggest
about the cause of the globulin 84
increase?
CASE 84 Case 84 is the same dog

as cases 82 and 83. Radiography
of the lumbar spine revealed an
osteoproliferative and osteolytic
lesion at the L3–L4 disc space (84).
The osteoproliferative and lytic lesion
at the disc space was interpreted
as discospondylitis. A myelogram was performed and the spinal cord was
compressed at this point, more severely on the left side. CSF was collected and
analyzed for protein and cell count and type at the time of the myelogram, and
no abnormalities were detected.
Results of a Brucella canis screening test (slide agglutination) were positive in
this dog, and a tube agglutination titer was 200.
1 What are the most common etiologic agents that cause discospondylitis in
dogs?
2 How would you interpret the Brucella canis test results?
3 What other signs would be expected in a neutered or intact dog with brucellosis?
53
Questions
85 CASE 85 An 8-month-old intact

male French Bulldog (85) was referred
because of a 12-week history of chronic
diarrhea. The dog had tenesmus, and
the owner frequently observed mucus
and sometimes fresh blood on the
feces. The dog had been treated by a
veterinarian over the last 10 weeks
for this problem. The veterinarian had
detected coccidian oocysts (Isospora
spp.) on fecal flotation and had treated
the dog for coccidiosis three times
without clinical improvement. There
was partial improvement in the
gastrointestinal signs when the dog was fed a hypoallergenic diet in combination
with oral amoxicillin for 7 days. After cessation of the antibiotics, the clinical signs
had worsened and the dog began to defecate in the house. The owners commenced
a new elimination diet (duck and potato based), which was fed for 2 weeks without
any other foods. There was no improvement in clinical signs with this treatment.
The dog lived in Nurnberg, Germany, and had never been outside the country. He
had received a full basic vaccination series and had been treated with fenbendazole
several times. He had never received medications to prevent ectoparasites.
On physical examination, the dog was bright, alert, and responsive. He was in
a good body condition. Rectal body temperature was 38.4°C (101.1°F), pulse was
104 bpm, and respiratory rate was 32 breaths/min. Mucous membranes were pink.
On palpation, the abdomen was tense, but not painful.
1 What are the typical clinical signs of large and small intestinal diarrhea, and
how would you categorize the diarrhea in this dog?
2 Do you think coccidiosis is a likely explanation for the chronic diarrhea in this
dog?
3 What part of the physical examination is missing, but absolutely indicated in
this case?
CASE 86 Case 86 is the same dog as case 85. On rectal examination, an

irregular and rough mucosa could be palpated, and mucoid feces could be seen
on the glove.
A CBC, biochemistry panel, urinalysis, and fecal flotation were performed. No
abnormal laboratory findings were present, and no parasites could be detected in
54
Questions
the feces. Abdominal radiographs were unremarkable. On abdominal ultrasound,
a thickened colonic wall (3 mm) was detected (86).
86
1 What causes of large bowel diarrhea are still on your differential diagnosis list?
2 How would you manage an idiopathic inflammatory bowel disease involving the
large intestine?
3 Why might colonic biopsies be indicated before starting immunosuppressive
therapy, especially in this case?

cases 85 and 86. A colonic biopsy was
performed endoscopically. Histologic
changes showed a moderate to severe
colitis with a predominance of neutrophils
(87). In addition, erosions and crypt
hyperplasia could be detected.
1 What test would you perform to

differentiate idiopathic neutrophilic
inflammatory bowel disease from
histiocytic colitis?
2 What is the cause of histiocytic
ulcerative colitis?
3 How would you treat a dog with
histiocytic ulcerative colitis, in contrast
to idiopathic inflammatory bowel
disease?
55
Questions
88 CASE 88 A 6-year-old neutered male

Golden Retriever was evaluated for a
history of weight loss and progressive
inappetence for 1 month (88). The
owner reported weakness, anorexia, and
moderately labored breathing over the
last 2 days. No vomiting, diarrhea, cough,
polyuria, or polydipsia was reported. The
dog was from San Diego, California,
USA, had supervised outdoor access,
and was up to date on vaccines. The last
healthcare visit had been 4 months ago,
and the dog had been clinically normal.
The owners used flea and tick preventives
only during spring and summer.
Physical examination revealed lethargy,
pyrexia (38.7°C [100.0°F]), a grade III/
VI diastolic decrescendo murmur at the
left heart base, and bounding pulses.
Otherwise, the physical examination
was unremarkable. Bloodwork revealed
leukocytosis, thrombocytopenia, elevated liver enzymes, and hypoalbuminemia
with hyperglobulinemia.
1 What is the most likely cause of the cardiac murmur?

2 Are the other abnormalities in this case associated with the cardiac disease?
89a CASE 89 Case 89 is the same dog as

case 88. Thoracic radiographs did not
reveal any parenchymal or vascular
abnormality in the lungs. The systolic
blood pressure was increased, but the
diastolic pressure was decreased, which
explained the bounding pulses. An
echocardiogram documented a large
vegetative lesion on the aortic valve (89a,
89b), causing moderate obstruction and
significant regurgitation.
56
Questions
1 How are the valvular vegetations 89b
formed, and how do they cause
cardiac murmurs?
2 What factors predispose to
endocarditis?
3 What are other systemic signs of
endocarditis?
4 Should any therapy be considered
pending microbiologic tests?
CASE 90 Case 90 is the same dog as cases 88 and 89. Pre-enrichment blood
culture in BAPGM (Bartonella alpha-proteobacteria growth medium) for 2 weeks
followed by culture in blood agar for another 2 weeks (90) yielded growth of
a gram-negative coccobacillus suggestive of Bartonella spp. Specific PCR assay
amplified Bartonella spp. DNA from the plate isolates, and DNA sequencing
confirmed infection with Bartonella vinsonii subspecies berkhoffii.
90
1 How did this dog become infected with B. vinsonii subspecies berkhoffii?
2 What are the most common Bartonella species that infect dogs, and what are
their reservoir hosts?
3 What are other signs of Bartonella spp. infection in dogs?
4 What is the recommended therapy for endocarditis caused by Bartonella spp.?
5 What are the public health implications of this diagnosis?
57
Questions
CASE 91 A 10-month-old intact male German Shepherd Dog from Bari, Italy,
was brought to a veterinarian for a routine wellness examination and vaccination.
On physical examination, a solitary depigmented papule with scaling margins was
identified adjacent to the left nostril (91). The owner had noticed the lesion about
2 months previously.
91
1 What is your assessment of the dermal lesion?

2 What further diagnostic tests are indicated?
CASE 92 Case 92 is the same dog as case 91. A few Leishmania amastigotes were
detected in fine needle aspiration smears (92, arrows), and a Leishmania infantum
PCR was positive. Therefore, a diagnosis of papular dermatitis associated with
L. infantum infection was made.
92
1 What treatment do you recommend for this dog?

2 How should the dog be monitored in the future?
58
Questions
CASE 93 A 12-week-old intact male 93
Yorkshire Terrier (93) was evaluated
for a 1-day history of vomiting,
diarrhea, and anorexia. The owners
lived in Munich, Germany, and had
purchased the dog over the internet
3 days previously. Therefore, the dog’s
origin was obscure and whether he had
received vaccinations and antiparasitic
treatment was unknown. On physical
examination, the dog was recumbent and dull but reacted to acoustic stimuli.
The heart rate was 220 bpm, pulse was weak, capillary refill time was 5 seconds,
mucous membranes were pale, peripheral limbs were cold, and respiratory rate
was 32 breaths/min. The dog weighed 0.5 kg. A fecal parvovirus antigen test was
performed and was positive.
1 What is the dog’s most life-threatening problem?

2 What initial treatment would you perform to address this problem?
3 What laboratory parameters should be assessed in order to optimize treatment?

case 93. After initial shock fluid therapy,
heart rate was 140 bpm, mucous
membranes were pink, capillary refill
time was 2 seconds, pulse was regular, but
the dog was still obtunded (94). Mucous
membranes were tacky, and skin turgor
was reduced. The dog was vomiting about
once an hour and had severe diarrhea
about four times per hour.
Initial laboratory work-up revealed a
hematocrit of 0.45 l/l (RI 0.35–0.58 l/l), a
total white blood cell count of 1.4 × 109/l
(RI 5–16 × 109/l), a neutrophil count of
0.2 × 109/l (RI 3–9 × 109/l), glucose of 1.2 mmol/l (RI 3.8–6.6 mmol/l), potassium
of 2.8 mmol/l (RI 3.8–5.5 mmol/l), creatinine of 54 µmol/l (RI 45–125 µmol/l), total
protein of 65 g/l (RI 56–78 g/l), and albumin of 32 g/l (RI 31–43 g/l).
1 What should be the fluid therapy plan for the next 10 hours?
2 What should be the nutritional plan when the vomiting is under control?
59
Questions
CASE 95 A 3-year-old neutered male German Shepherd Dog was evaluated for a
cloudy and painful right eye (95) with increased redness and ocular discharge. The
dog had appeared a little more lethargic over the last week. The owners lived in
two places, and traveled regularly between Munich, Germany, and Ravenna, Italy.
In Italy, the house was located near a wooded area close to dense shrubs, and the
owners took their dog for frequent walks. The dog had been properly vaccinated
and never had any previous health issues. He had received his last treatment for
endoparasites and flea preventive about 6 months ago.
95
Physical examination was unremarkable besides the ocular changes. An

ophthalmic examination was performed. In the right eye, blepharospasm,
photophobia, and ocular discharge were observed. The cornea did not stain with
fluorescein. Slit lamp examination of the anterior chamber revealed a moderate
amount of aqueous flare (positive Tyndall effect). The surface of the iris was
hyperemic and mildly swollen (rubeosis iridis), and the pupil was miotic.
Ophthalmic Right eye Left eye

examination (OD) (OS)
Menace response Positive Positive
Dazzle reflex Positive Positive
Pupillary light reflex Complete Complete
1 What is the ocular diagnosis based on the clinical findings?

60
Questions
CASE 96 Case 96 is the same dog as case 95. For fundic examination, the
pupils of both eyes were dilated with 1% tropicamide. The examination of
the right fundus was difficult owing to the flare in the anterior chamber, but
in the left eye the retina was visible (96). A CBC and a biochemistry panel were
performed.
Complete Reference 96
blood count Results interval
Red blood cells 7.3 × 1012/l 5.5–9.3
Platelets 23 × 109/l 150–500
Eosinophils 0.22 × 109/l 0–1.0
Basophils 0 × 109/l 0–0.04
Lymphocytes 1.46 × 109/l 1.0–3.6
Monocytes 0.44 × 109/l 0.04–0.50
Biochemistry Reference
panel Results interval
ALT 21 U/l 0–110
ALP 21 U/l 0–152
Bilirubin 0.1 μmol/l 0–5.3
Creatinine 79.6 μmol/l 35.4–159.1
BUN 6.6 mmol/l 2.6–9.9
Glucose 5.2 mmol/l 3.8–6.6
Sodium 144 mmol/l 139–163
Potassium 4.1 mmol/l 3.8–5.5
Chloride 112 mmol/l 105–118
Calcium 2.5 mmol/l 2.0–3.1
Phosphorus 1.4 mmol/l 0.7–2.0
1 What is your interpretation of the findings in the left retina?

2 What is your interpretation of the laboratory findings?
3 What underlying disease would you suspect, based on the physical examination,
the ophthalmic findings, and the laboratory results? What additional diagnostic
tests would you recommend?
61
Questions
97 CASE 97 Case 97 is the same dog as

cases 95 and 96. Rickettsial morulae were
detected on the blood smear (97), and the
dog was positive for Ehrlichia canis by
PCR.
1
What Ehrlichia species infect dogs, and
how are they transmitted?
2
Describe the different phases of canine
monocytic ehrlichiosis, including the
typical clinical signs.
3 What is the most common ocular finding in dogs with canine monocytic
ehrlichiosis, and what is the pathogenesis?
4 What systemic and ophthalmic treatment would you recommend?

Siberian Husky was evaluated for a
4-day history of progressive anorexia,
restlessness, irritability, and vocalization.
On the day of evaluation, the dog had
become aggressive toward the household
members and developed hypersalivation
(98). The dog lived in Budapest, Hungary,
in an apartment and was walked regularly
next to the house only. One month
previously, the owner had returned from
vacation in the countryside in the area of
Debrecen, Hungary, near the Romanian border, where the dog had escaped
several times and roamed in the forest area. The owner was not aware of any
exposure to toxins or trauma. The dog had been vaccinated against distemper,
parvovirus infection, and canine infectious hepatitis twice as a puppy; the
last dose was at 13 weeks of age. There was no other history of illness or
medications.
On physical examination, pyrexia (40.5°C [104.9°F]), hypersalivation, and
mydriasis were seen in addition to the neurologic signs described above.
1 How likely is rabies in this dog, considering that a bite wound was not seen?
2 How can a diagnosis of rabies be made?
3 How would you treat a dog suspected to have rabies?
62
Questions
CASE 99 A 3-year-old neutered female 99
Jack Russell Terrier was evaluated for
multifocal areas of erythema, scaling,
and mild crusting on the distal front
limbs (99). The disease had begun
2 weeks previously with mild hair loss.
The affected areas gradually increased
and lesions became more prominent,
but pruritus was marginal. The dog
otherwise was bright and alert and
showed no other clinical signs. The dog
lived in Ingolstadt, Germany, was used
for hunting, had never been outside the
country, and was regularly vaccinated
and treated with antiparasitic drugs.
Physical examination showed no
abnormalities besides the skin lesions.

2 Name three other differential diagnoses.
3 What diagnostic tests are indicated in this dog?
CASE 100 Case 100 is the same dog as case 99. A fungal culture was positive for
Microsporum gypseum (100).
100

2 How would you treat the environment around this dog?
3 What recommendations should be provided to the owner to minimize the
chance of zoonotic transmission?
63
Questions
101a CASE 101 A 1-year-old neutered

female Boxer dog was evaluated for
ocular changes, lethargy, and pain in
the back, neck, and head. The dog had
a slightly hunched posture and kept
the head lowered during walking. The
owner had observed color changes
in both eyes (101a). The dog lived in
Brighton, UK, and had never traveled
outside the country. The dog was
fully vaccinated, but deworming had
not been performed since puppy age
and she was not on any ectoparasite
101b control program.
Physical examination was normal
besides the neurologic and ophthalmic
changes. The neurologic examination
showed reduced postural reactions
in the pelvic limbs, weakness in
the right thoracic and pelvic limbs,
positional nystagmus, severe neck
pain, kyphosis, low head carriage, and
lethargy. The ophthalmic examination
showed scleral hemorrhage bilaterally
101c (101b, 101c). Retropulsion of the right
eye was painful for the dog. Further
diagnostic work-up included a CBC,
a biochemistry panel, urinalysis, and a
coagulation profile. In the CBC, a mild
thrombocytopenia was noted. The
coagulation profile showed prolonged
prothrombin and activated partial
thromboplastin clotting times.

Menace response Absent Present
Pupillary light reflex Normal (direct and indirect) Normal (direct and indirect)
64
Questions
An MRI (101d, 101e) was performed and revealed a lesion with irregular
margins within the left occipital lobe, which measured 2.2 cm in length, 2.6 cm in
height, and 7 mm in width. The lesion was markedly hyperintense on T2-weighted
images with a hypointense rim; on T1-weighted images it was hypointense. On T2
it showed a heterogeneous signal void. It had a mass effect, causing a mild right
midline shift. There was white matter hyperintensity surrounding the lesion. There
was a linear signal void within the third and the central aspect of the left lateral
ventricle. A pinpoint T2 signal void was visible within the rostral aspect of the left
occipital lobe, the central aspect of the left occipital lobe, and left lateral to the
caudal aspect of the vermis.
101d 101e
1 What is your assessment of the ocular lesions?

2 What is the MRI diagnosis?
3 What would be the primary infectious agent to test for, and what is the test of
choice?

case 101. Baermann faecal flotation (102) showed
Angiostrongylus vasorum larvae.
1 What is the epidemiology and pathophysiology

of angiostrongylosis?
2 What treatment would you suggest?
65
Questions
CASE 103 An 8-year-old neutered male mixed-breed dog was evaluated for a
long-term history of chronic recurrent cough. The dog had been seen repeatedly
by several different veterinarians and managed using various courses of different
antimicrobial drugs. Over the past 2 months,
the cough had become progressively more
103a
frequent despite treatment with antibiotics
and cough suppressants. The dog lived in
Sacramento, California, USA, and had no
travel history outside California. He had
received core vaccinations every 3 years
for the last 6 years, but had never been
administered prophylaxis for parasitic
infections.
On physical examination, the dog had
a temperature of 38.9°C (102.0°F), pulse
of 136 bpm, and respiratory rate of 28
breaths/min. Harsh crackles (expiratory
louder than inspiratory) were auscultated
in all lung fields. Increased airway sounds
were apparent on tracheal auscultation
and a harsh cough was easily elicited on
tracheal palpation. Thoracic radiographs
were obtained (103a, 103b).
103b
1 How would you interpret the radiographic findings?

2 What underlying disease process could be present?
3 What complications are possible?
66
Questions
CASE 104 Case 104 is the same dog as case 103 (104). Pulse oximetry revealed
an oxygen saturation of 87%. A CBC was obtained:
Complete blood Reference 104

count Results interval
MCV 70.2 fl 58–72
Platelets 414 × 109/l 150–500
Eosinophils 1.494 × 109/l 0–1.0
Basophils 1.494 × 109/l 0–0.04
Lymphocytes 0.747 × 109/l 1–3.6
Monocytes 0.498 × 109/l 0.04–0.5
1 How would you interpret the pulse oximetry reading?

CASE 105 A 6-year-old neutered male 105a

Rottweiler living in Davis, California,
USA, was evaluated for a bilateral
nasal discharge. The dog was otherwise
healthy, had been vaccinated regularly,
and was on heartworm prophylaxis.
Physical examination revealed no
abnormalities besides bilateral mucoid
nasal discharge. Rhinoscopy and a brush
cytology were performed (105a, 105b).
1 How would you interpret the

rhinoscopy findings?
2 How would you interpret the cytologic
findings in this dog?
3 What treatment should be considered? 105b
67
Questions
CASE 106 An 8-year-old neutered female Dachshund mix (106a) was referred
for evaluation of a non-healing bite wound. Seven months previously, the owner
had witnessed a dog fight between this dog and one of his other five dogs. Multiple
deep puncture wounds were noted immediately afterwards on the Dachshund
mix’s caudal dorsum. A veterinarian anesthetized the dog, the wounds were
cleaned and debrided, and two Penrose drains were placed. The dog was then
treated with cephalexin (30 mg/kg PO q12h). Although an Elizabethan collar was
placed on the dog, the owner removed it 2 days later and the dog started to lick
the wounds. The owner (who was a nurse) removed the drains 3 weeks later, but
the wounds continued to drain and a new wound appeared in the left axilla. Two
months later, the veterinarian performed exploratory surgery of the region. All
necrotic tissue was excised, and the dog was treated with clindamycin (20 mg/kg
PO q12h). Although there appeared to be initial improvement, draining lesions
then recurred and intermittent pyrexia was noted (39.4–40.1°C [102.9–104.2°F])
over the next 4 months. Shortly after, a new draining tract appeared on the left
thorax. Throughout the entire 7-month period, the dog otherwise was bright, alert,
and eating normally. There was no other significant medical history. The dog lived
in Fresno, central California, USA, and had not traveled to other places. The dog
was regularly vaccinated and on endo- and ectoparasite control.
On physical examination, the dog was bright and alert. The temperature was
39.6°C (103.3°F), while other vital signs were normal. The BCS was 7/9. The
caudal aspect of the dog’s dorsum was concave in appearance on the left side and
had multifocal to coalescing linear ulcerated lesions that were draining purulent
material (106b). Soft tissue in the left inguinal region was firm and painful.
A draining tract was also noted on the right side of the dorsal abdomen, and
surrounding soft tissue was enlarged and firm. The soft tissue in the left axilla
106a 106b
68
Questions
was firm with two healing draining tracts. There was no evidence of peripheral
lymphadenopathy.
1 What is your differential diagnosis for the non-healing wounds?

2 What diagnostic tests would you recommend for this dog?
CASE 107 Case 107 is the same dog as case 106. The CBC showed a
moderate mature neutrophilia (31.85 × 109 cells/l) with a mild left shift (2.54
× 109 band neutrophils/l, RI 0–0.3 × 109/l). A biochemistry panel showed mild
hypoalbuminemia (30 g/l, RI 34–43 g/l) and hypoglobulinemia (32 g/l, RI 17–
31 g/l). Ultrasound of the region showed no large fluid pockets or foreign material,
only heterogeneous, hyperechoic, and disorganized tissue. Histopathology of a
biopsy revealed marked multifocal chronic pyogranulomatous cellulitis (107).
All special stains were negative for organisms. Culture revealed small numbers of
Enterococcus faecalis from enrichment broth (likely a contaminant) and very small
numbers of a rapidly growing mycobacterial species. The mycobacterial culture
was sent to a specialized laboratory for further identification of the species, which
was found to be Mycobacterium abscessus (by rpoB gene sequencing).
107
1 Which other rapidly growing mycobacterial species can infect dogs and cats?
2 How does the clinical presentation of disease caused by rapidly growing
mycobacteria differ from that caused by Mycobacterium avium?
3 What is the zoonotic potential of this organism?
4 How should this infection be treated?
69
Questions
108 CASE 108 A 6-year-old neutered female

Boxer mix from Bern, Switzerland, was
evaluated for PU/PD, reduced appetite, and
weight loss of several months’ duration.
Previously, increased serum urea nitrogen
concentration was detected on bloodwork
and, thereafter, the dog had been fed
a prescription renal diet. The dog had
received regular vaccinations (distemper,
hepatitis, parvovirus) and regular treatment
for internal parasites. On physical
examination, the dog appeared lethargic
and had a body condition score 3/9 (108).
Otherwise, the physical examination was
unremarkable. A CBC, biochemistry panel,
and urinalysis were performed:

MCV 71 fl 64–73
MCH 23 pg 23–26
MCHC 34 g/dl 34–36

Cholesterol 6 mmol/l 3.5–8.6

Collection method Cystocentesis –
Color, appearance Light yellow, slightly turbid –
Specific gravity 1.021 –
pH 5 5.5–7
Protein ++++ –
Glucose Negative –
Continued
70
Questions

Ketone Negative –
Bilirubin + –
Blood + –
Protein to creatinine ratio 9.67 0–0.5
Red blood cells 12–20 cells/hpf 0–5
White blood cells 12–20 cells/hpf 0–3
Casts Several/hpf 0
Bacteria Large quantities/hpf 0
1 How would you interpret the laboratory results?

2 What further work-up would you suggest?
CASE 109 Case 109 is the same dog as case 108. Further work-up revealed the
presence of Leishmania spp. antibodies by ELISA (109). An immunofluorescent
antibody test was also performed and a high titer was obtained considered
consistent with infection.
109
1 Does leishmaniosis explain the clinical abnormalities in this dog?

71
Questions

Labrador Retriever was evaluated for
an alopecic annular lesion on the nose
of about 1 cm in diameter (110). The
owner had noticed this lesion about a
week previously and it seemed not to
have increased in size. There had been
no signs of pruritus. The owner was
concerned about ringworm. The dog
lived in Warsaw, Poland, had received a
complete basic vaccination series, and
had been treated for endoparasites and
ectoparasites every 3 months. The owner
reported that, about 4 weeks before the appearance of the lesion, a healthy stray kitten
had been adopted from a shelter. The kitten and the dog had been playing together.
On physical examination, slight erythema and scaling were noted in association with
the lesion. No other lesions were detected. The dog appeared otherwise healthy.
1 Is this lesion consistent with dermatophytosis?

2 What is a “dermatophyte”?
3 What tests should be done if dermatophytosis is suspected?
111 CASE 111 Case 111 is the same dog as case

110. Microsporum canis was cultured from the
hairs and skin scrapings of this lesion (111).
1 What was the likely source of Microsporum

canis infection in this dog?
3 Can the dog transmit this disease to other
animals or humans?
72
Questions
female 10 kg mixed-breed dog (112)
was evaluated for weakness and pale
mucous membranes. The dog lived in
Munich, Germany, and had returned
2 days previously from a vacation in
Salerno, Italy. The dog had only been
vaccinated as a puppy and had not
received any antiparasitic treatment
or preventives within at least the last
5 years.
On evaluation, the dog was lethargic, had very pale mucous membranes,
a capillary refill time of 2 seconds, a heart rate of 186 bpm, bounding pulses, and a
rectal body temperature of 39.6°C (103.3°F). No other abnormalities were noted.
1 What differential diagnoses should be considered for mucosal pallor, and what
is your assessment for this dog?

as case 112. The dog had a hematocrit
of 0.15 l/l. A blood smear was obtained
(113). The dog (10 kg) needed a blood
transfusion, but no stored blood was
available. However, the owner offered
to bring in a 5-year-old Rottweiler
(50 kg), which belonged to the son of
the owner, as a blood donor. This dog
was healthy, completely vaccinated,
and received preventive treatment for
parasites regularly.

2 What factors have to be addressed
and kept in mind before and during
a blood transfusion?
73
Questions
CASE 114 A 10-year-old neutered female Miniature Poodle was referred for
signs of increasing pain and discomfort that had become progressively worse in
the last 2 months. She had become reluctant to jump up on furniture, as previously
accustomed to doing. The dog was evaluated by a veterinarian, and generalized
lymphadenomegaly and elevated rectal temperatures that ranged from 38.5 to
41.0°C (101.3 to 105.8°F) were noted. The dog lived in Savannah, Georgia, USA,
had never traveled. She had an irregular vaccination history. Parasiticides had not
been applied for at least the last 2 years.
On presentation, the dog appeared stiff with a dorsally arched spine (114).
The dog was mentally alert. Postural reactions were assessed, and the limbs had
normal initiation on hopping reaction with
114 delayed or stiff follow through. There were
no deficits in any of the limbs with respect to
conscious proprioceptive testing. Myotatic and
flexor reflexes were present but weak motor
movements were noted. The dog was painful
on palpation of muscles in the extremities
and paraspinal regions and on flexion and
extension of the limbs. The remainder of the
1 What are the two underlying pathophysiologic processes associated with

hyperesthesia?
2 Are the four anatomic structures associated with diffuse hyperesthesia?
3 What are two underlying pathophysiologic processes associated with elevated
rectal temperature?
CASE 115 Case 115 is the same dog as case 114. Ophthalmologic examination,
including fundic examination, was performed and showed no lesions.
A CBC, biochemistry profile, and urinalysis were done, and revealed a marked
leukocytosis (50.5 × 109/l) with neutrophilia (42.3 × 109/l), a left shift (5.3 × 109/l),
and a mild increase in creatine kinase activity (2,547 U/l). Radiographs of the
axial and appendicular skeleton revealed periosteal proliferation of the pelvis
and proximal aspects of the pelvic limbs (115a). The results of CSF analysis were
normal. Muscle biopsy findings showed a purulent and eosinophilic myositis. In
some areas of the musculature, cysts with an “onion skin”-type appearance were
found (115b).
74
Questions
115a 115b
1 Which organ systems are likely to be responsible for the hyperesthesia in this
dog, and how can this be associated with fever?
2 Which type of organism is seen in the muscle biopsy (e.g. virus, bacterium)?
3 What infectious diseases caused by these types of organisms are associated with
polymyositis?
4 Which of these organisms can additionally cause polyperiostitis?
CASE 116 Case 116 is the same dog as cases 115 and 116
114. The dog was treated for hepatozoonosis and her gait
improved during the course of 6 months of continuous
therapy (116).
1 What drugs are used in the treatment of hepatozoonosis,

and how long must treatment be continued?
2 How do the clinical manifestations and diagnostic
findings differ between Hepatozoon canis and
Hepatozoon americanum infection?
75
Questions

Labrador Retriever from Minneapolis,
Minnesota, USA, was evaluated for a
3-day history of inappetence, lethargy,
shifting-leg lameness, and reluctance to
walk. There was no history of trauma or
recent travel. The dog frequently hiked
with the owner. The dog was regularly
vaccinated with core vaccines, but had not
been treated for endoparasites in the last
year. According to the owner, ectoparasite
preventives were only used during the
117b “tick season”. No other medications had
been administered to the dog.
On arrival at the veterinary clinic,
the dog refused to walk and had to
be transported on a gurney (117a).
On physical examination, the body
temperature was 40°C [104°F], and
the popliteal lymph nodes were slightly
enlarged and firm on palpation. Joints were
painful when manipulated, especially the
pelvic limb joints, but joint effusion was
not detectable. Neurologic examination
was within normal limits, but the dog was
reluctant to bear weight with his pelvic limbs (117b). No other abnormalities were
detected during physical examination, and no ectoparasites were noted.
1 What are the most likely differential diagnoses for this case?
2 What diagnostic testing should initially be performed?
118 CASE 118 Case 118 is the same dog

as case 117. A CBC showed a mild non-
regenerative anemia, lymphopenia (0.5 ×
109 lymphocytes/l, RI 1–5 × 109/l), and
thrombocytopenia (85 × 109 platelets/l,
RI 150–400 × 109/l). A blood smear was
obtained (118). A serum biochemistry
profile and urinalysis were within normal
limits. Radiographs of affected limbs did
not show evidence of erosive disease in
76
Questions
any joint. Arthrocentesis of both stifle and tarsal joints was performed bilaterally.
Cytologic examination of synovial fluid revealed decreased viscosity, 6,500
nucleated cells/μl (RI <3,000 cells/μl) with 75% non-degenerate neutrophils
(RI <5%), 37 g/l protein (RI <25 g/l), and absence of bacteria.
1 What is the structure seen in the neutrophil?

2 What conclusions can be made from the results of the synovial fluid analysis?
CASE 119 Case 119 is the same 119

dog as cases 117 and 118. An in-
clinic ELISA assay (SNAP 4Dx Plus,
IDEXX Laboratories) was negative for
antibodies to Borrelia burgdorferi and
Ehrlichia canis, (and Ehrlichia ewingii),
and for antigens of Dirofilaria immitis,
but it was positive for Anaplasma spp.
antibodies (119).
1 Does this result alone confirm a diagnosis of granulocytic anaplasmosis?

2 What other tests could be performed?
3 What is the treatment for this disease in dogs?
4 What is the prognosis in this case?

male Retriever mix (120) was presented
to a veterinary clinic for a consultation.
The owner of the dog had died
from tuberculosis 1 week previously.
Throughout the last 3 months, the dog
had stayed almost constantly in the
bedroom in close contact with the owner,
who did not leave his bed. The son’s
family now needed to decide whether
they would keep the dog, and wanted
to know whether the dog could have contracted infection with Mycobacterium
tuberculosis. The family had a 2-month-old baby. The dog had lived in Regensburg,
Germany, and now had moved to Munich, Germany. Previous travel history as well
as vaccination and parasite control status of the dog were unknown.
On physical examination, the dog was unremarkable apart from some dental
tartar and a slightly thin body condition (3.5/9).
1 What is the likelihood that the dog was infected with Mycobacterium tuberculosis?
2 Are there diagnostic tests that can rule out the possibility of infection in this dog?
77
Questions
CASE 121 A 12-week-old intact male English Bulldog was evaluated for acute
onset of respiratory difficulty followed by vomiting yellow to clear fluid. The
dog lived in San Francisco, California, USA, had been acquired from a breeder
4 weeks previously, and had visited his local veterinarian 1 week previously for
examination and vaccinations. He was being regularly treated for internal parasites
and the second vaccination in the series was scheduled in 4 weeks. On physical
examination, he had a temperature of 38.7°C (101.7°F), pulse of 160 bpm, and
respiratory rate of 80 breaths/min with marked abdominal effort. Mild mucoid
nasal and ocular discharges were present and inspiratory and expiratory stertor was
audible without a stethoscope. Crackles were auscultated diffusely across all lung
fields. The remainder of the physical
examination was unremarkable. 121b
Thoracic radiographs were obtained
(121a, 121b).
121a
1 What is your interpretation of the thoracic radiographs?

3 What diagnostic tests should be performed?
CASE 122 Case 122 is the same dog as case 121. A CBC was performed.
A biochemistry panel showed hyperphosphatemia of 2.9 mmol/l (RI 1–1.6 mmol/l)
and a slightly elevated ALP of 190 U/l (RI 0–152 U/l) (consistent with a growing
puppy). The dog was closely monitored (122). Pulse oximetry results varied from
93 to 94%. PCR of blood, urine, and conjunctival scrapings for canine distemper
virus was negative.
78
Questions
Complete Reference 122

blood count Results interval
MCV 69.3 fl 58–72
Reticulocytes 66.0 × 109/l –
Platelets 800 × 109/l 150–500
Eosinophils 0.0 × 109/l 0–1.0
Basophils 0.0 × 109/l 0–0.04
Lymphocytes 1.013 × 109/l 1–3.6
Monocytes 2.702 × 109/l 0.04–0.5

2 What stabilizing treatment should be provided?
3 What follow-up tests should be considered?

male mixed-breed dog (123) was
referred for evaluation of progressive
limb edema. The dog had been
diagnosed with leishmaniosis 5 years
ago and was on allopurinol treatment.
He had not been vaccinated within
the last 5 years, but received parasite
prevention on a regular basis. The dog
originally came from Rome, Italy, but
for the last 6 years had lived in Munich,
Germany, without any additional travel
history. Physical examination revealed
edema that involved all four limbs. No
other abnormalities were noted.
1 What is a likely explanation for the

edema, based on the history?
2 How could the problem and its
clinical consequences be addressed?
79
Questions
124 CASE 124 A 6-year-old neutered

male, 20.6 kg mixed breed dog (124)
was referred for a cardiac work-up,
because the referring veterinarian had
heard a new continuous heart murmur.
The dog was known to have had a
systolic murmur for several years.
Along with dental prophylaxis, a grade
I mast cell tumor had been surgically
removed from the right thoracic limb
1 year previously. There was no history
of exercise intolerance or other clinical
signs. The dog lived in Ingolstadt,
Germany, and was current on vaccinations and treated regularly with parasiticides.
He had never traveled outside Germany.
Physical examination revealed that the dog was active, alert, and responsive.
The rectal temperature was 38.9°C (102.0°F), mucosal membranes were moist and
pink, capillary refill time was <2 seconds, all lymph nodes were of normal size, and
abdominal palpation was unremarkable. Lung sounds were physiologic, and the
respiratory rate was 36 breaths/min. A left basal continuous heart murmur with an
intensity of V/VI was audible. The regular heart rate was 128 bpm. Pulse quality
was normal, without pulse deficit or evidence of jugular vein distension/pulsation.
The remainder of the physical examination was unremarkable.
1 What is your interpretation of the physical examination, and what are the
differential diagnoses for the described heart murmurs?
2 What further diagnostic procedure should be recommended?
CASE 125 Case 125 is the same dog as case 124. Echocardiography was
performed. A left apical five-chamber view (125a), a colour Doppler image (125b),
and a CW Doppler image (125c) are shown.
125a 125b
80
Questions
125c
1 What is your interpretation of the echocardiographic images?

2 What is your main differential diagnosis?
CASE 126 Case 126 is the same dog as cases 124 and 125. Erysipelothrix
rhusiopathiae was grown from all three blood cultures taken from the jugular and
peripheral veins. While culture was pending, antimicrobial drug treatment was
commenced with a combination of amoxicillin–clavulanic acid and enrofloxacin. The
E. rhusiopathiae isolate was susceptible to amoxicillin–clavulanic acid but resistant
to enrofloxacin, so enrofloxacin treatment was discontinued. The dog remained alert
and responsive during treatment (126); however, he died suddenly 2 weeks later,
possibly as a result of a thromboembolic event or an arrhythmia.
1 What are the suggested criteria for 126

diagnosis of infective endocarditis?
2 What are known predisposing factors
for endocarditis?
3 What is the general prognosis for
dogs with endocarditis?
81
Questions

Weimaraner was evaluated for a history of
intermittent diarrhea that had been occurring
over the last 2 months. The diarrhea was
characterized by small volumes of feces with
tenesmus, and intermittent hematochezia.
One week prior to examination, the dog had
a grand mal seizure and began to circle to
the left side. The owner observed a reduced
mental awareness. The dog also appeared
to have lost visual acuity as he was observed
to bump into objects in his environment and
could not visually track silently moving objects.
This visual dysfunction was recognized to be
separate from and despite the dog’s neurologic
127b impairments. The dog lived in Atlanta, Georgia,
USA, and had no travel history. He was fully
vaccinated and received regular endoparasite
and ectoparasite control.
Physical examination was unremarkable
besides the neurologic and ophthalmologic
abnormalities. The dog had a depressed mental
status and would stand with his head and
neck flexed to the left (127a). He had reduced
noxious perception of pain with stimulation
of the right nares. The left eye had a mydriatic
pupil with cloudiness of the anterior chamber.
There was a reduced menace response in both
visual fields of the left eye. The right pupil
was miotic, the left pupil was mydriatic (127b). Pupillary light reflexes were present
bilaterally, although pupillary constriction was slow when the light was directed into
the left eye.
1 What are the body systems in which problems were identified in this dog?
2 Where would you suspect the neurologic localization?
3 What would be your diagnostic plans for the various problems?
CASE 128 Case 128 is the same dog as case 127. Rectal scraping cytology was
performed (128; Diff-Quik stain ×1,000). Ophthalmoscopic findings included
aqueous flare in the anterior chambers of both eyes. Multifocal granulomatous
white to gray lesions were observed on the retinas of both eyes and there was
almost complete retinal detachment on the left side.
82
Questions
In this dog, abnormal findings 128
on analysis of CSF from the
cerebellomedullary cisterna were an
increased total nuclear cell count
of 1,150/µl (reference value <5/µl)
and a total protein concentration of
1,240 mg/dl (reference value <30 mg/
dl). The diferential cell count on a
cytocentrifuged Wright–Giemsa-stained
preparation showed many nucleated
cells and few erythrocytes. Nucleated cells consisted of 50% eosinophils 40% non-
degenerative neutrophils, 10% small lymphocytes, and occasional macrophages.
Some macrophages showed erythrophagocytosis and hemosiderin pigment
granules. Rare variably stained 15–20 µm basophilic organisms, with a granular
texture and a clear unstained halo, were surrounded by phagocytic cells.
1 What organisms can be seen on the rectal scraping cytology?

2 What diagnostic tests could be performed for definitive diagnosis of this disease?
3 Are there any treatment options for this disease?

Old English Sheepdog was evaluated for
a 4-day history of lethargy, inappetence,
vomiting, and occasional cough. The
dog had been adopted as a stray,
3 weeks before the onset of clinical
signs, in Poznan, Poland. It had been
vaccinated against rabies and treated
for endoparasites and ectoparasites at
the time of adoption, but no other vaccines had been administered.
On physical examination, the dog was febrile (40.3°C [104.5°F]), lethargic, icteric
(129), had a stiff gait, abdominal pain, and appeared dehydrated with a capillary refill
time of 3 seconds. A CBC revealed neutrophilia with a left shift, thrombocytopenia,
high serum urea nitrogen and creatinine concentration, increased liver enzyme activities,
and hyperbilirubinemia. Leptospirosis was suspected. Subsequent to hospitalization, a
microscopic agglutination test (MAT) to detect antibodies against different Leptospira
serovars was performed. The resulting titers were as follows: serovar Canicola 1:200,
Icterohaemorrhagiae negative, Grippotyphosa 1:800, Australis 1:100.
1 Can such titers result from previous vaccination with Leptospira vaccines?
2 What is the diagnostic significance of MAT results in a non-vaccinated dog?
3 What other tests could help to confirm or rule out leptospirosis?
83
Questions
130 CASE 130 A 6-month-old intact male Pug

(130) was evaluated for a 3-day history of
vomiting, lethargy, and anorexia. The dog had
been purchased from a breeder in Nurnberg,
Germany, at the age of 10 weeks, and lived
now in Munich, Germany. He had never been
outside Germany. There were no other dogs
in the household, but there were two cats. The
dog had been vaccinated against parvovirus
and distemper virus twice, at the age of 6 and
10 weeks. The dog had been dewormed at
the age of 6 weeks but never since. He had
not received any ectoparasite control.
very lethargic and slightly dehydrated. The
abdomen was tense and the bowel loops
appeared fluid-filled. A CBC was performed.

Red blood cells 5.6 × 1012/l 5.5–9.3
Hemoglobin 7.53 mmol/l 7.45–12.5
Platelets 440 × 109/l 150–500
Eosinophils 0 × 109/l 0–1.0
Basophils 0.04 × 109/l 0–0.04
Lymphocytes 1.03 × 109/l 1–3.6
Monocytes 0.31 × 109/l 0.04–0.5
1 What is your differential diagnosis for the leucopenia?

2 Can a vaccinated dog develop parvovirosis?
3 Could a dog become infected with parvovirus from a cat?
84
Questions
CASE 131 Case 131 is the same dog as case 130. The 131
results of a fecal SNAP parvovirus antigen test (IDEXX
Laboratories) supported the diagnosis of parvovirosis (131).
1 What supportive treatment is appropriate in a dog

with parvovirosis?
2 Which antibiotics should be used?
CASE 132 Case 132 is the same dog as cases 131 and 130. Although treated
intensively, the dog was not improving. Additional treatment options, including
recombinant feline interferon-ω (132), were considered.
132
1 Is treatment with recombinant feline interferon-ω useful?

2 Is administration of specific antibodies useful?
3 Are drugs that increase the neutrophil count available and useful?
85
Questions
CASE 133 A 2-year-old male mixed-breed dog, originating from Santa Maria,
Brazil, was evaluated because over the last 5 days he had shown lethargy, anorexia,
hematochezia, vomiting, weight loss, dark yellow colored urine, and bleeding at the
ear pinnal margins. The dog had been regularly vaccinated, but had not received
any parasite control within the last year.
Physical examination revealed a poor body condition (BCS 3/9), pale and icteric
mucous membranes, peripheral generalized lymphadenomegaly, splenomegaly,
hepatomegaly, intermittent fever, and extensive subcutaneous hemorrhage (133a).
Ticks were found around the dog’s ears and feet. A CBC, biochemistry panel, and
urinalysis were performed (for significant findings see below). On the blood smear,
polychromasia, normoblastemia, spherocytosis, anisocytosis, and Howell–Jolly
bodies (133b) were noted. There was agglutination of red blood cells on the tube
wall.
133a 133b

MCV 105 fl 58–72
MCHC 24.7 mmol/l 19–21
Platelets 61 × 109/l 150–500
Monocytes 1.8 × 109/l 0.04–0.5

ALT 36 U/l 18–110
ALP 45 U/l 13–152
Total protein 64 g/l 55.5–77.6
Bilirubin 10.2 μmol/l 0–5.3
86
Questions
Urinalysis Results
Color, appearance Dark yellow
Bilirubin 3+
Hemoglobin Negative
1 How is the anemia in this dog classified, and what are the main differential
diagnoses?
2 What diagnostic tests should be performed next?

as case 133. Tests for serum antibodies
against Borrelia burgdorferi, Ehrlichia
canis, Ehrlichia ewingii, Anaplasma
spp., and Leishmania spp., as well as
for antigens of Dirofilaria immitis, were
negative. Cytologic examination of a
fine needle aspirate of the left popliteal
lymph node was performed (134).
1 What are the cytologic findings in the

lymph node aspirate?
2 Can a definitive diagnosis be made?

dog as cases 133 and 134. The dog
was hospitalized for treatment. The
hemorrhagic diarrhea and vomiting
ceased, and the dog started to eat and
drink after 3 days of hospitalization.
After 2 weeks, the dog’s clinical
condition improved, and the icterus
resolved (135). The dog was discharged
from the hospital, and treatment was
continued at home.
1 What is the recommended treatment for this patient?

2 The owner has two other dogs. What preventive measures should be
recommended?
87
Questions
CASE 136 A 3-year-old neutered female Doberman Pinscher was evaluated for acute
cough and respiratory distress that the owner had first noticed 3 days previously.
Before this episode, the dog was in good condition, and there was no previous history
of illness. The dog lived in the San Francisco Bay area, California, USA, and had
never traveled outside of this region. She was regularly vaccinated and received
preventive treatments for endoparasites and ectoparasites on a regular basis.
136 was listless. She had tachypnea with
crackles on auscultation of the thorax,
and a respiratory rate of approximately
70 bpm. The pulse rate was 160–
210 bpm. A grade III/VI left-sided
apical heart murmur was detected,
with hyperkinetic but synchronous
femoral pulses. The BCS was 5/9.
Thoracic radiographs showed a severe
interstitial to alveolar pattern in the
caudodorsal lung lobes and mild left
atrial enlargement. An echocardiogram
showed moderate left atrial enlargement. A hyperechoic, oscillating lesion was seen
on the aortic valve cusps (136, arrow). Severe aortic insufficiency was also present.
1 What is your main differential diagnosis for the lesion on the aortic valve,
including infectious agents potentially involved, and which pathogen seems
most likely based on the clinical findings?
2 What additional diagnostic tests would you recommend?
3 How should this dog be treated pending the results of those diagnostic tests?

case 136 (137). The CBC showed a mild
non-regenerative anemia (hematocrit
0.32 l/l, RI 0.35–0.58 l/l) with a mild
mature neutrophilia (14.227 × 109 cells/l,
RI 3–115 × 109/l). The biochemistry panel
revealed hyponatremia (142 mmol/l,
RI 145–154 mmol/l), hypochloremia
(96 mmol/l, RI 105–116 mmol/l),
hyperglycemia (7.6 mmol/l, RI 3.9–
6.5 mmol/l), increased serum urea
nitrogen concentration (14.6 mmol/l,
RI 2.9–11.1 mmol/l), and increased
88
Questions
activities of serum ALP (210 U/l, RI 15–127 U/l) and serum ALT (73 U/l, RI 19–
67 U/l). Urinalysis showed a specific gravity of 1.012 and a benign sediment. Blood
cultures were negative. A Bartonella vinsonii subsp. berkhoffii antibody test was
positive at 1:256, a Bartonella henselae antibody test was positive at 1:64, and a
Bartonella clarridgeiae antibody test was negative.
1 Do the antibody test results prove that Bartonella spp. infection is the cause
of endocarditis in this dog, and would it rule out Bartonella spp. infection as a
cause of disease if the test results had been negative?
2 What is the prognosis for recovery?
3 What is the zoonotic potential of Bartonella spp.?
CASE 138 A young puppy of about 3 months of age was adopted 3 days
previously from a rescue shelter in Munich, Germany, where it had been boarded
for at least 14 days after living as a stray. The dog was vaccinated once on entry into
the shelter with an attenuated live canine distemper, adenovirus, and parvovirus
vaccine. The new owner noticed a cough, mucopurulent nasal discharge, and
diarrhea 1 day after adoption. On contacting the shelter, the owner was informed
that several other dogs had developed similar signs and two puppies had died with
seizures. On physical examination the puppy appeared weak and lethargic. Rectal
temperature was elevated (40.2°C [104.7°F]) and the dog had a mucopurulent
nasal discharge and conjunctivitis (138a). There were harsh lung sounds on
auscultation. Hyperkeratosis was noted on examination of the footpads (138b).
A CBC revealed mild lymphopenia but a normal neutrophil count.
138a 138b
1 What is the main differential diagnosis?

2 What diagnostic tests should be considered?
3 What treatment is recommended, and what is the prognosis?
89
Questions

Doberman Pinscher was evaluated for
a 2-day history of lethargy, anorexia,
and reluctance to ambulate. The dog
lived in Palermo, Italy. It had received
complete vaccinations against distemper,
adenovirus, parvovirus, Leptospira, and
rabies, and was on regular heartworm
prophylaxis.
clinical findings included elevated
temperature (39.9°C [103.8°F]), cervical
pain, and a stiff neck. The remainder of the physical examination, including a
detailed neurologic examination, was unremarkable. A radiograph of the cervical
region was obtained (139).
1 What would be your differential diagnoses for the clinical presentation in this
dog (before radiographs were obtained)?
2 What is your interpretation of the radiograph?
3 What diagnostic tests should also be performed?
CASE 140 Case 140 is the same dog as case 139. Staphylococcus pseudintermedius
bacteriuria was documented by urinalysis and culture, and was associated with
urinary cystoliths (140a, 140b). The same bacterial species was isolated from two
out of three blood cultures. Susceptibility testing showed that all isolates were
broadly susceptible, including to all beta-lactam drugs tested. Thus, the source of
the organism causing the discospondylitis was suspected to be the urinary tract.
140a 140b
90
Questions
1 What other common sources of infection can be associated with discospondylitis?
2 What are the most common infectious agents associated with discospondylitis?
4 What is the likely composition of the urolith?
CASE 141 A 3-year-old neutered male American Pitbull Terrier from Tulsa,
Oklahoma, USA, was evaluated for lethargy, inappetence, and a stiff gait of 2 days’
duration. The dog was up to date on core vaccines and had received heartworm
and flea preventatives monthly. The owner took the dog for hikes at weekends, and
had found an attached tick 1 week previously. No history of trauma, travel, access
to toxins, or previous illnesses was reported.
Physical examination revealed approximately 5% dehydration, a rectal temperature
of 40.1°C (104.2°F), petechiation of mucous membranes (141), moderate bilateral
prescapular lymphadenomegaly, and splenomegaly. The dog seemed painful during
the examination, but the pain could not be localized to a specific area. No swelling
or joint effusion was present. Neurologic examination was within normal limits.
The only abnormalities found on bloodwork were thrombocytopenia (130 × 109
platelets/l, RI 150–400 × 109/l) and slight hypoalbuminemia (25 g/l, RI 28–40 g/l). An
in-clinic ELISA (4Dx SNAP Plus, IDEXX Laboratories) was negative for antibodies
to Anaplasma spp., Borrelia burgdorferi, Ehrlichia canis (and Ehrlichia ewingii),
and antigens of Dirofilaria immitis. A PCR panel for detection of Anaplasma spp.,
Ehrlichia spp., Babesia spp., and Bartonella spp. DNA was also negative.
1 What are your primary differential diagnoses?

2 What would be the next diagnostic step?
141
91
Questions
142 CASE 142 A 6-month-old intact male Labrador

Retriever was evaluated for acute diarrhea and
lethargy (142). Anorexia, refusal to walk, and
diarrhea had started 24 hours before evaluation,
and the diarrhea progressed in frequency. For the
3 hours before evaluation, the dog had watery
diarrhea every 30 minutes. The dog lived in
Munich, Germany, and had never been outside the
country. He had received a full basic vaccination
series, had been treated with endoparasiticides
several times, and was on a regular ectoparasite
control program. The dog had been fed a raw
meat diet over the last 3 months.
On physical examination, the dog showed
signs of shock. He was mentally obtunded.
Mucous membranes were pink, but tacky. Pulse
quality was good. Capillary refill time was
1 second. Heart rate and respiratory rate were
140 bpm and 36 breaths/min, respectively,
without abnormal findings on auscultation. On
palpation, the abdomen was tense. Rectal body temperature was 40.7°C (105.3°F).
The remainder of the physical examination was unremarkable.
1 What are the two clinical phases of shock, and what phase was present in this
dog?
2 What are the five pathophysiologic types of shock?
3 How would you characterize the pathophysiologic type of shock in this dog?
CASE 143 143 is the same dog as case 142. On ultrasound, the small intestine
appeared partly corrugated (143). A 15-cm segment of the jejunal wall was
143
92
Questions
thickened when compared with other parts of the small intestine, with a lack of
normal intestinal wall layering. In addition, a mesenteric lymph node in the mid-
abdomen was moderately enlarged (diameter 1.5–2 cm; length 4–5 cm) and of
heterogeneous echogenicity. A CBC was performed.

Red blood cells 5.56 ×1012/l 5.5–9.3
Hemoglobin 7.73 mmol/l 7.45–12.5
Platelets 211 × 109/l 150–500
Eosinophils 0 × 109/l 0–1.0
Basophils 0 × 109/l 0–0.04
Lymphocytes 3.21 × 109/l 1–3.6
Monocytes 0.41 × 109/l 0.04–0.5
1 Which bacterial species are considered to be enteropathogenic?

2 What are limitations of a fecal culture?
3 How might you make a diagnosis of an enteropathogenic bacterial infection in
this case?
CASE 144 Case 144 is the same dog as cases 142 and 143. The enlarged lymph node
was aspirated with a fine needle, and the aspirated fluid was transferred into a transport
medium and submitted for culture. In addition, two
separate blood culture specimens of 10 ml were taken
144
at a 30-minute interval from two different sites after
aseptic preparation of the skin. Blood specimens were
immediately inoculated into a blood culture system
using a fresh needle. The bottles were submitted for
aerobic and anaerobic bacterial culture.
After taking specimens for bacterial culture,
antibiotic treatment was started with enrofloxacin
(144). With fluid therapy and antibiotics, the
dog improved clinically. On the second day
after treatment, the dog showed normal vital
parameters and was afebrile. After 3 days of
treatment, the diarrhea had resolved and the dog
was discharged on oral enrofloxacin and a low fat,
highly digestible diet.
93
Questions
Blood cultures were negative, but Salmonella spp. were isolated from the lymph
node aspirates. Susceptibility testing revealed that the isolate was susceptible
to enrofloxacin. A diagnosis of acute intestinal Salmonella spp. infection with
bacterial translocation and sepsis was made.
1 Should antibiotics be administered to every patient with acute diarrhea and

suspicion of an enteric bacterial infection?
2 Do you think antibiotics were indicated in this case?
3 Is there a potential zoonotic risk?
4 What would your recommendations be to the owner?
CASE 145 A 5-month-old intact male American Pitbull Terrier was referred with
a 5-day history of progressive illness. For the first 2 days of illness, the dog’s clinical
signs consisted of lethargy and mild inappetence. On the following day, the owner
noticed that the dog had a stiff gait, anorexia, and difficulty opening his mouth.
Subsequently, the owner noticed “muscle spasms”, which progressed over 24 hours
despite treatment with flumethasone, antibiotics, and intravenous fluids at a local
veterinary clinic. On admission, the dog was in lateral recumbency with spastic
hyperextension of all limbs, extension of the tail, and generalized muscular spastic
rigidity (145). Rectal temperature was 41.1°C (106.0°F), heart rate 186 bpm, and
respiratory rate 54 breaths/min. Hypersensitivity to external stimuli was present,
which resulted in profound muscular spasms.
145

2 What are potential differential diagnoses?
3 How is the diagnosis confirmed?
5 What are the most common complications of this disease?
94
Questions
CASE 146 Case 146 is the same dog as case 145. 146
The most common early signs of generalized tetanus
are ocular and facial muscular abnormalities (risus
sardonicus) (146), progressing to rigidity of other
muscles. Localized tetanus, which involves only one
portion of the body adjacent to the wound, is less
common but has a better prognosis.
1 How is Clostridium tetani transmitted?

2 What could be the source of infection in this
dog?
3 What treatment would be recommended?
CASE 147 A 3-year-old neutered male Golden Retriever was evaluated for a
3-week history of progressive cough, decreased appetite, and weight loss. The dog
lived in Minneapolis, Minnesota, USA, and had no history of traveling. He was
regularly vaccinated and received regular antiparasitic treatment.
Physical examination revealed a quiet but alert and responsive dog in thin
body condition (BCS 3/9). The dog’s rectal temperature was 39.7°C (103.5°F),
the respiratory rate was 40 breaths/min, and pulse rate was 100 beats/min. There
were no other physical examination findings apart from two firm, non-ulcerated
cutaneous nodules, one on the trunk (1 cm in diameter) and one on the left distal
pelvic limb (0.5 cm in diameter). The left popliteal lymph node was also slightly
enlarged and firm. A fundic examination
was normal. Thoracic radiographs showed 147
hilar lymphadenomegaly and multifocal
pulmonary nodules, as well as some patchy
alveolar infiltrates. Cytologic examination
of a fine needle aspirate of the left popliteal
lymph node revealed yeast organisms
consistent with Blastomyces spp. (147)
1 What is the geographic distribution of

Blastomyces spp.?
2 What are other anatomic sites of
predilection of this organism?
3 Had the cutaneous lesions not been identified, what other diagnostic tests could
have been used to obtain the diagnosis, and what are the limitations of these tests?
95
Questions
148 CASE 148 A 6-month-old intact female

Golden Retriever was evaluated for two
focal regions of hypotrichosis on the
muzzle (148) of several weeks’ duration.
The dog was otherwise well, had a good
appetite, and was not pruritic. The dog
had been regularly vaccinated with core
vaccines and was regularly treated for
endoparasites. She lived in Munich,
Germany, and had never been outside
the country.
On physical examination, the only
pathologic findings were the lesions
described. The affected skin was not erythematous, but was slightly thicker than in
adjacent areas and hyperpigmented.
1 What are your differential diagnoses?

2 What tests would you propose?
CASE 149 Case 149 is the same dog as case 148. Cytology revealed keratinocytes
and occasional cocci. A deep skin scraping showed mites (149).
149
1 What is the prognosis for the disease in this dog?

96
Questions
CASE 150 A 2-year-old mixed-breed dog from Munich, Germany, was evaluated
for acute cough of 3 days’ duration. The cough began while the dog was boarded
in a kennel for 7 days. The owners reported that the dog seemed slightly lethargic
and showed a decreased appetite. The dog was up to date on vaccinations
(distemper, adenovirus, parvovirus, parainfluenza, Bordetella, Leptospira, and
rabies) and was receiving monthly milbemycin for parasites.
150a
was febrile (rectal temperature 40.3°C
[104.5°F]), had a bilateral nasal discharge
(150a), and harsh inspiratory and expiratory
lung sounds on auscultation. Bloodwork was
performed and revealed a neutrophilia with
a left shift. Radiography was also performed
(150b, 150c).
1 What is the most likely diagnosis in this

dog, based on the history and clinical
signs?
2 How would you interpret the radiographs?
150b 150c
97
Questions
CASE 151 A 4-year-old intact male Dachshund Terrier (151) was referred
because of a 6-week history of elevated serum liver enzyme activities. Six weeks
previously, the dog had an episode of vomiting and lethargy that lasted 2 days.
The dog had been evaluated by a veterinarian at that time who had treated the
dog with antiemetics and oral antibiotics (amoxicillin–clavulanic acid). The dog
improved and appeared healthy thereafter, but elevated ALT and ALP enzyme
activities were noted on several rechecks. The dog lived in Ingolstadt, Germany,
and had never traveled. The owner worked as a forest ranger and the dog was used
as a hunting dog. The dog was up to date on vaccinations, was treated about twice
a year for endoparasites, and received ectoparasite control. No previous health
problems were known.
151
On physical examination, the dog was bright, alert, and responsive, and in good
body condition (BCS 4.5/9). On palpation, the abdomen appeared tense, but was
not painful. The remainder of the physical examination was unremarkable.
1 What drugs can result in increased serum liver enzyme activity without liver
damage?
2 Which extrahepatic diseases can result in increased serum liver enzyme activity?
3 What is the half-life of serum ALT and ALP in dogs?
4 Can a single insult to hepatocytes result in elevated liver enzymes for a period
of 6 weeks?
5 Which non-invasive diagnostic tests should be performed to assess the
significance of a chronic increase in liver enzyme activities?
98
Questions
CASE 152 Case 152 is the same dog as case 151. An abdominal ultrasound
examination was performed. The liver was moderately enlarged and only small
parts of the liver showed a normal architecture. Much of the liver parenchyma
appeared heterogeneous with increased echogenicity (152). The remainder of the
liver had a normal appearance.
152
1 What is the most likely differential diagnosis based on the ultrasound

examination findings?
2 What would be your next diagnostic step?

as cases 151 and 152. Several abnormal
structures were identified on cytologic
examination of fine needle aspirates of
the liver (153).
1 What is the diagnosis in this dog,

and what forms of this disease are
known?
2 Is cytologic identification sufficient
to define the species involved, and
what tests would be superior?
3 What is the life cycle of this agent and the required hosts?
4 How did the dog in this case fit into the life cycle?
99
Questions
CASE 154 A 1-year-old intact female Poodle living close to Pelotas, Brazil, was
evaluated for lethargy, inappetence, and weight loss for several weeks. No vomiting
or diarrhea was noted, but the owner reported dark feces and “skin rashes” (154a,
154b), which had been observed over the last 3 days. The owner also reported
frequent tick infestations, which were treated with amitraz. The dog was up to date
on core vaccines and was regularly treated for endoparasites. No access to toxins
or plants and no history of trauma, medications, or travel was reported.
Physical examination revealed lethargy, a rectal temperature of 39.5°C
[103.1°F], pale mucous membranes, moderately enlarged peripheral lymph nodes,
splenomegaly, mucosal petechiation, and skin ecchymoses.
154a 154b
1 What are the differential diagnoses for the petechiation and ecchymoses?
2 What diagnotic tests should be recommended?
CASE 155 Case 155 is the same dog as case 154. A CBC and serum biochemistry
panel were performed (for significant results see the boxes). A blood smear was also
evaluated (155a, 155b). Collection of a free catch urine sample was not possible
and cystocentesis was not performed because of the bleeding disorder.
155a 155b
100
Questions
Complete Reference Biochemistry Reference

blood count Results interval panel Results interval
Hematocrit 0.15 l/l 0.35–0.58 ALT 145 U/l 18–110
Reticulocytes 0 × 109/l 0–60 ALP 180 U/l 13–152
Neutrophil count 0.8 × 109/l 3–9 Total protein 94 g/l 56–78
Monocyte count 0.01 × 109/l 0.04–0.5 Albumin 25 g/l 31–43
Platelets 8 × 109/l 150–500 Globulins 69 g/l 24–35
1 What conclusions can you make based on the laboratory test results?
2 What initial treatment is required in this case?
CASE 156 Case 156 is the same dog as cases 154 and 155. During physical
examination on the second day of hospitalization, an irregular cardiac rhythm was
auscultated, with asynchronous femoral pulses. An ECG was performed (156). In
addition, blood pressure measurement was performed. The blood pressure was
140 mmHg (systolic). Also, free catch urine could now be obtained and submitted
for analysis.
Urinalysis Results
pH 7.2
Protein 3+
Glucose Negative
Bilirubin Negative
The urine sediment was benign and the UPCR was 10.2 (RI <0.5).
156
1 What are the important findings from the ECG and urinalysis?
2 Is specific therapy required for these findings?
3 What is the prognosis in this dog?
101
Questions
157 CASE 157 A 1.5-year-old neutered female

Boxer dog was evaluated for right thoracic limb
lameness and swelling of the carpus of 3 weeks’
duration. There had been no response to non-
steroidal anti-inflammatory drugs (deracoxib
1.5 mg/kg PO q12h) prescribed by her veterinarian
when the lameness first began. The owner also
reported that, over the last month, the dog had
four episodes of inappetence that resolved within
24 hours. She was currently eating well. There had
been no cough, sneezing, vomiting or diarrhea,
or increased thirst and urination. There was no
history of exposure to trauma. The dog lived
in Sacramento, California, USA. Travel history
consisted of several visits to Arizona over the last
year, with the last visit being 3 months previously.
She was up to date on routine vaccinations and
was the only pet in the household.
Physical examination was normal apart from
moderate weight-bearing lameness of the right
thoracic limb and a firm swelling over the right
carpus and distal antebrachium that was painful
on palpation. Funduscopic examination was normal. Radiographs of the right
carpus revealed moth-eaten osteolysis throughout the distal radius, with cortical
bone destruction along the cranial aspect of the distal radial diaphysis. There was
solid periosteal new bone circumferentially surrounding the distal radius, which
was most pronounced along the caudomedial cortices. There was also moderate
soft tissue swelling surrounding the distal right antebrachium (157).
1 What are the main differential diagnoses, including specific infectious agents
that might be involved?
2 What other diagnostic tests should be recommended for this dog?
CASE 158 Case 158 is the same dog as case 157 (158). Further diagnostic work-
up was performed. The CBC and urinalysis were normal and a biochemistry
panel revealed moderate hyperglobulinemia (43 g/l, RI 17–31 g/l) and mild
hypoalbuminemia (32 g/l, RI 34–43 g/l). Thoracic radiographs were unremarkable.
Fine needle aspirates of the lesion showed moderate mixed inflammation that was
characterized by a mixture of non-degenerate neutrophils, histiocytes, reactive
102
Questions
lymphocytes, and occasional multinucleated 158
osteoclasts. A Coccidioides spp. antibody
titer was positive at 1:64.
1 What is the significance of the positive

Coccidioides spp. antibody test?
2 Are any additional diagnostic tests
indicated?
3 What is the recommended treatment for
this patient, and what are the possible
adverse effects of therapy?
CASE 159 A 5-month-old intact female 159

Australian Labradoodle (159) was evaluated
for several episodes of soft feces within
the last 3 months. The dog belonged to a
veterinarian who had performed centrifugal
zinc sulfate flotation and the test was
positive. The dog had been treated several
times with fenbendazole and metronidazole,
but the Giardia spp. test remained positive
at three consecutive testings, and the fecal
consistency did not improve. Tests for other
endoparasites had been negative. The dog
was on a commercial puppy diet, was eating
well, and had no vomiting. The dog had been
born in Australia and was imported into
Germany at the age of 10 weeks. Since then,
the dog had lived in Munich and had not traveled outside Germany. She had contact
with many dogs, because she was attending puppy school and was allowed to run
free in parks and around the veterinary hospital. She had received a complete basic
vaccination series and was on monthly endo- and ectoparasite treatment.
Physical examination was unremarkable, and the dog was alert and responsive.
The BCS was 4/9.
1 What are likely reasons that the Giardia spp. test remained positive?
103
Questions
160 CASE 160 An 8-year-old neutered

female German Shepherd Dog mix
was referred for evaluation of reverse
sneezing followed by epistaxis from the
right nostril (160). Signs were first noted 3
months ago and had become progressively
worse. The referring veterinarian had used
an otoscope to search for a foreign body
but none was found. A dental procedure
was performed under anesthesia to
investigate tooth root disease as a cause
of the epistaxis but signs continued. The
dog lived in a rural area close to Davis,
California, USA, had no travel history,
and was regularly vaccinated and on
heartworm prophylaxis.
On presentation, the dog was mildly obtunded with a rectal temperature of
38.4°C (101.1°F), pulse of 100 bpm, and respiratory rate of 32 breaths/min. Mild
intermittent blepharospasm was noted bilaterally, along with a brown serous to
crusted ocular discharge. Nasal airflow was present bilaterally; however, the dog
resisted full examination of the head and oral cavity. The right mandibular lymph
node was enlarged (2 cm).
1 What are the most likely differential diagnoses for the problems of unilateral
epistaxis and ipsilateral lymphadenopathy?
2 If only one diagnostic test was allowed in this patient, what would you perform?
3 If the owner agreed to a full work-up, what would you recommend?
CASE 161 Case 161 is the same dog as case 160. A test for Aspergillus spp.
antibodies was negative. Cytologic examination of a lymph node aspirate (161a)
and CT of the nasal cavity (161b, c) were performed.
161a
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Questions
161b 161c
1 What is your interpretation of the lymph node cytology?

2 What is your interpretation of the CT images?

Jack Russell Terrier was evaluated for
a single skin lesion on the lateral thorax
that the owner had discovered 3 days
ago (162). The dog was a bright and
alert hunting dog and had no other
known illnesses besides the skin lesion.
The lesion was moderately pruritic. The
dog lived in Regensburg, Germany, and
had never been outside the country. He
received regular core vaccinations and
preventive treatment for endoparasites
and ectoparasites.
Physical examination was unremark-
able besides the small skin lesion.
1 What are the main differential diagnoses?

2 What would you recommend as the minimal diagnostic approach for this case?
3 What is the most complete diagnostic approach to this case?
105
Questions

mixed-breed dog was evaluated because
of a 4-day history of left-sided head tilt
and uncoordinated gait that had become
progressively worse over that time.
The dog lived in Messina, Italy. He was
regularly vaccinated with core vaccines and
received prophylaxis for endoparasites and
ectoparasites.
findings included a left-sided head tilt,
circling and falling, Horner’s syndrome,
facial nerve paralysis (163), and positional strabismus on the left side. Neurologic
examination revealed no abnormalities in mentation, placing reaction abnormalities,
limb paresis/paralysis, or involvement of other cranial nerves.

2 What is your initial diagnostic plan?
CASE 164 Case 164 is the same dog as case 163. Otoscopic evaluation was
performed under sedation and revealed exudate in the left horizontal ear canal
(164). The tympanic membranes could not be examined because of severe ear
canal stenosis. Open-mouth anterior–posterior radiographs of the skull revealed
a bilateral thickening of the bullae that was more severe on the left side.
164

2 What additional diagnostic tests might be useful to better understand the condition?
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Questions
Wirehair mix dog was evaluated
by an emergency clinic for a 2-day
history of anorexia, vomiting,
and agitation. Over the last day,
the owner noted that the dog had
developed severe pruritis, especially
involving the head. The dog lived in
a village about 30 km from Krakow,
Poland, and was used as a hunting
dog. Four days before the onset of
clinical signs, the dog had been in contact with, and possibly consumed, a wild
boar carcass. The dog was vaccinated against rabies, but not against any other
infectious diseases and had not been treated with any antiparasitic drugs.
On physical examination, the dog was obtunded, vocalizing, and in lateral
recumbency. Tachycardia, tachypnea, fever (40.6°C [105.1°F]), and hypersalivation
were noted. In addition, tremor, strabismus, and anisocoria were identified. Around
the mouth, on the lips, and in the temporal area, asymmetric excoriations due to
self-mutilation were apparent (165).

2 What other differential diagnoses are there for the neurologic signs combined
with fever?
CASE 166 Case 166 is the same dog as case 165. The dog died within a few
hours. Lesions noted at necropsy, due to self-mutilation, were also found on the
gingiva, tongue, and buccal mucosa (166).
166
1 How is a diagnosis of Aujeszky’s disease confirmed?

2 What was the likely source of this infection in this case?
3 Can a dog with Aujeszky’s disease infect other animals?
4 Is Aujeszky’s disease a zoonosis?
107
Questions
CASE 167 A 2-year-old neutered female Labrador Retriever was referred for
cutaneous lesions that had been present for 10 days. The dog had been treated
with oral marbofloxacin for the past week. The dog had lived in the countryside
close to Athens, Georgia, USA, for her entire life. The owners had a lakefront
property, and the dog spent up to 2 hours per day in the lake. The dog had been
regularly vaccinated and received regular prophylactic treatment for ecto- and
endoparasites.
On physical examination, non-pruritic ulcerative nodular cutaneous lesions on
the right carpus and left tarsus were seen (167). The masses were 4–6 cm long and
2 cm wide, with overlying erythematous, alopecic, and ulcerated skin. Popliteal
and prescapular lymph nodes of the respective limbs were enlarged and firm. The
remainder of the physical examination was unremarkable.
167
1 What are the differential diagnoses for nodular ulcerative skin lesions?
2 What would be the diagnostic plan to evaluate the skin lesions?
CASE 168 Case 168 is the same dog as case 167. Fine needle aspirate cytology,
examined with a modified Wright’s stain, showed granulomatous and eosinophilic
inflammation; however, organisms were not observed. Radiographic findings
revealed only mild periosteal proliferation on bones of the affected carpal joint.
Histopathology of a biopsy sample showed severe, multifocal, eosinophilic
to pyogranulomatous deep dermatitis with fibroplasia and neovascularization.
Intralesional filamentous structures were observed. They did not stain with periodic
acid–Schiff stain. With Gomori’s methenamine silver stain, wide (5–10 μm)
bulbous, irregularly septate branching hyphae were observed (168). Aseptically
obtained skin biopsy specimens were cultured on blood agar, MacConkey agar,
Sabouraud dextrose agar, and Mycosel agar plates. All cultures were negative.
However, tests for anti-Pythium insidiosum antibodies were positive. PCR was
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Questions
performed on tissue specimens taken from the biopsy and confirmed the presence
of Pythium spp. in the lesions.
168
1 What are the treatment options for Pythium insidiosum infection?

2 What other genera of bacteria or fungi can cause ulcerated (with or without
drainage) nodular granulomatous or pyogranulomatous skin lesions in dogs?
CASE 169 A 6-month-old female 169

Dachshund (169) was presented for
a consultation. The dog had lived
together with one of her male siblings at
the owner’s house for the last 3 months.
The male sibling had mild diarrhea since
he was introduced into the household,
but the female puppy had normal
feces. A fecal PCR panel for infectious
agents was performed on the feces of
both dogs and was unremarkable in
the diarrheic male dog, but coronavirus
RNA was detected in the feces of the
the female dog. The owner was seeking
advice concerning coronavirus infection. The dog lived in Munich, Germany, and
had no travel history. The dog had received a full basic vaccination series and been
treated for endoparasites five times within the last 3 months. She had also received
ectoparasite treatment once a month. Physical examination was unremarkable.
1 What coronaviruses are known to infect dogs, and what is their role as pathogenic
agents?
2 Is it necessary to treat this dog for coronavirus infection?
109
Questions
CASE 170 A 5-year-old intact male German Shepherd Dog was evaluated because
of “red eyes” and sudden loss of vision. The dog was kept entirely outdoors in Bari,
Italy. He was only vaccinated against rabies and had not been regularly treated for
endoparasites or ectoparasites.
Physical examination revealed pale mucous membranes and enlargement
of peripheral lymph nodes and the spleen. On ophthalmic examination, severe
bilateral hyphema (170a) was identified. A CBC, biochemistry panel, coagulation
tests, and urinalysis, as well as cytology of a fine needle aspirate of the enlarged
lymph nodes, were performed. The relevant abnormalities were moderate non-
regenerative anemia (0.21 l/l, RI 0.37–0.55 l/l), moderate neutropenia (1.2 × 109
cells/l, RI 3–115 × 109/l), severe thrombocytopenia (5 × 109 platelets/l, RI 150–
400 × 109/l), hyperglobulinemia (70 g/l, RI 24–35 g/l), hypoalbuminemia (21 g/l,
RI 29–37 g/l), proteinuria with a UPCR of 2.5, slightly prolonged PT and aPTT,
as well as severely prolonged buccal mucosal bleeding time. Plasmacytosis was
identified in the lymph node cytology (170b).
170a 170b
1 What are the main problems in this dog, and what are the most important
differential diagnoses?
2 What diagnostic procedures should be performed next?

case 170. High antibody titers were present
for both Ehrlichia canis (1:12,800) and
Leishmania infantum (1:128). Bone marrow
cytology confirmed severe plasmacytosis
and hypoplasia of all other cell lineages.
In addition, L. infantum amastigotes were
found in the bone marrow (171, arrow).
PCR of a lymph node aspirate was positive
for E. canis. Therefore, both infectious
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Questions
diseases, ehrlichiosis and leishmaniosis, associated with bone marrow suppression
and possible glomerulonephritis were diagnosed.
1 What are possible complications in this dog secondary to the abnormalities

identified?
2 What treatment should be given and what is the prognosis?
CASE 172 An 8-year-old neutered male Chihuahua was evaluated for a 2-day
history of anorexia and lethargy. The dog had shifting-leg lameness and was
reluctant to walk (172). The dog lived in a rural area close to Bemidji, Minnesota,
USA, mostly indoors but with supervised
access to the woods. Ticks had been found
172
on the dog at least twice in the previous
6 months, despite regular treatment with
fipronil. The dog had received regular core
vaccinations, but had not been treated for
endoparasites for the last 5 years.
Physical examination revealed a
temperature of 39.9°C (103.8°F), stiffness,
and joint pain, which was most evident
in the carpal joints. A CBC revealed mild
thrombocytopenia (125 × 109 platelets/l, RI
150–400 × 109/l). The biochemistry panel was
within normal limits, but urinalysis revealed
1+ proteinuria with a specific gravity of
1.045 and a benign sediment. Synovial fluid
analysis showed 15,872 WBC/μl (normal
<3,000 cells/μl), with 90% non-degenerate
neutrophils (normal <5%), 35 g/l protein
(normal <25 g/l), and absence of bacteria.
An in-house ELISA (SNAP 4Dx Plus, IDEXX
Laboratories) was positive for antibodies to
the C6 peptide of Borrelia burgdorferi.
1 How should the ELISA result be interpreted in this case?

2 What other diagnostic tests should be considered?
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Questions

Caucasian Shepherd Dog, used as a
watchdog on a sheep farm in Przemysl,
Poland (close to the Ukrainian border),
was evaluated for sudden onset of
lameness, inappetence, and lethargy.
The owner had not noticed any
trauma recently. The vaccination and
antiparasitic treatment history was
unclear, because the dog was brought
to the veterinarian by the owner’s son,
who had little knowledge about the
dog’s history.
dog appeared disorientated and had ataxia due to pelvic limb paresis. Pyrexia
was present (39.9°C [103.8°F]). The dog had anisocoria, reduced pupillary
light responses, and an inability to swallow water (which ran back out of the
dog’s mouth). A CBC revealed neutrophilia and mild lymphopenia. Additional
diagnostics were declined by the owners. Treatment with IV fluid therapy and
antimicrobial drugs was initiated.
On day 2 of hospitalization, the dog showed generalized incoordination, seizures,
and hypersalivation due to a “dropped jaw”. This progressed to torticollis, coma,
and death on the same day (173). At that time the owner recalled that the dog had
been in a fight with a fox about 2 months previously, in a region where rabies was
endemic in red foxes. The dog had never received any vaccination against rabies.
1 Considering that the dog did not show aggression, could this still be rabies?
2 Could detection of antibodies have been helpful to confirm or rule out rabies in
this dog?
3 How should dogs be protected from rabies?
CASE 174 A 1-year-old intact male mixed-breed dog was evaluated for a 4-day
history of lethargy, inappetence, reluctance to move, vomiting, and diarrhea, which
had recently progressed to hematochezia. The dog lived in a suburban area near
Krakow, Poland, and was frequently walked in the forest on a leash. The dog had
never been vaccinated or treated for parasites.
Physical examination revealed fever (40.0°C [104.0°F]), tachypnea, tachycardia,
mild dehydration, tonsillar enlargement, and pharyngeal hyperemia. An in-house
test for fecal canine parvovirus antigen was negative (174). The dog was started
on intravenous fluid therapy and amoxicillin–clavulanic acid. There was no
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Questions
clinical improvement over the following 24 hours and 174
the dog’s rectal temperature remained at 40.1°C. During
physical examination on day 2 of hospitalization, cranial
abdominal pain was noted. A CBC revealed neutrophilia,
thrombocytopenia, hyperbilirubinemia, hypoalbuminemia,
and severely increased activities of serum ALT and ALP.
1 What are the main differential diagnoses for the

vomiting and diarrhea before the laboratory results are
available?
2 What are the main differential diagnoses after the
laboratory results become available?
3 What other diagnostic tests should be performed?

dog as 174. Abdominal ultrasound
showed that the liver was diffusely
hyperechoic and enlarged with
rounded lobar edges. Changes
consistent with gallbladder edema
were visible. Mesenteric lymph nodes
were enlarged and a small amount of
free peritoneal fluid was noted. The
dog’s blood tested positive by PCR
for canine adenovirus 1 (CAV-1).
The dog improved gradually with supportive treatment, and within a few days
started to eat again. During this convalescent phase (about 10 days after onset of
the disease), the owner noted opacity of the right cornea (175). The other eye was
unaffected and the dog was clinically otherwise apparently healthy.
1 What is the pathogenesis of the ocular changes?

3 How should the ocular disease be treated?
4 What could have been the source of CAV-1 infection in this dog?
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Questions
CASE 176 A 1-year-old neutered female Poodle was evaluated for a 6-month
history of intermittent cough and gagging episodes that did not coincide with
eating, drinking, or exercise. These episodes persisted for weeks at a time and were
sometimes accompanied by lethargy and inappetence. The dog lived in Sacramento,
California, USA, had received her basic vaccination series, and was on heartworm
prophylaxis; she had been neutered at around 6 months of age. A local veterinarian
had examined the dog and a lateral thoracic radiograph had been obtained (176).
The dog had been treated with one course of 7 days of amoxicillin–clavulanic acid
but the cough had not improved.
176
On physical examination, the temperature was 39.1°C (102.4°F), pulse 124 bpm,

respiratory rate 32 breaths/min, and spontaneous coughing occurred throughout
the examination. Normal bronchovesicular lung sounds were present in all lung
fields and a cough was easily elicited on tracheal palpation. The remainder of the
physical examination was normal.
1 What is your interpretation of the radiograph?

2 What differential diagnoses should you consider?
3 What additional diagnostic tests should be performed?
CASE 177 Case 177 is the same dog as case 176. The owners elected to
have bronchoscopy performed (177a). Based on the bronchoscopic findings,
bronchoscopic-guided brush biopsies and cytology of impression smears of the
brushings were performed (177b).
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Questions
177a 177b
1 With what disease process are the bronchoscopic image and the histopathology
most consistent?
2 Is there an additional diagnostic test that could have provided the diagnosis
prior to bronchoscopy?
CASE 178 A 6-month-old intact 178

female Wire-haired Dachshund (178)
was evaluated at a wellness visit that
included advice regarding a planned
trip to Italy. The owner reported that the
dog was apparently healthy and eating
well. However, the owner’s husband
currently had influenza and the dog
used to sleep in their bed. The owner
was worried that the dog could contract
influenza from her husband and wanted
to know whether the husband should
sleep in a separate room.
The dog lived in Munich, Germany, and had never been outside the country.
The dog had received a basic vaccination series at 8 weeks, 12 weeks, and 16 weeks
of age, and was treated for endoparasites and ectoparasites regularly. Physical
examination was unremarkable.
1 What influenza viruses can infect dogs?

2 Are dogs with influenza virus infection a zoonotic risk?
3 What is the risk of the husband transmitting infection to the dog?
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Questions
CASE 179 A 3-year-old neutered male Chow/Golden Retriever mix was evaluated
for a 3-month history of progressive large bowel diarrhea with hematochezia.
There had been no improvement with metronidazole, a combination of
amoxicillin–clavulanic acid and enrofloxacin, or a low fat diet. One month after
the signs began, the dog was treated with prednisone (0.5 mg/kg PO q12h) with
initial improvement, but when the dose was tapered 1 week later, the diarrhea
recurred and did not resolve when the dose was increased again. Over the last
month, the frequency of diarrhea with hematochezia had increased to eight times/
day. Vomiting began a week before presentation and was occurring every other
day, containing bile or food. The dog was eating a normal amount of food, but was
slower to eat than normal. The dog had been rescued 2 years previously and had an
unknown travel history before that time. He now lived in Sacramento, California,
USA. Since then, travel had been limited to the San Francisco Bay area. The dog
was up to date on routine vaccinations (distemper, adenovirus, parvovirus, rabies)
and was on regular ecto- and endoparasite control.
Physical examination revealed a bright, alert, and well-hydrated dog with
normal vital signs and a BCS of 3/9. The only abnormal finding was pain on rectal
examination, and soft to liquid brown diarrhea on the glove, with frank blood.
A CBC was unremarkable apart from thrombocytopenia (72 × 109 platelets/l,
RI 150–400 × 109 l/l). A biochemistry panel showed hyperglobulinemia (42 g/l,
RI 17–31 g/l) and mild hypoalbuminemia (28 g/l, RI 34–43 g/l). Urinalysis was
unremarkable. A centrifugal zinc sulfate fecal flotation was negative. Abdominal
ultrasound showed an enlarged and hyperechoic liver. The spleen was mildly
enlarged and had a diffuse hypoechoic
mottling. The mesenteric, colic, and
179 sublumbar lymph nodes were mildly
enlarged and hypoechoic. There was
multifocal bowel wall thickening with
associated loss of wall layering within
the duodenum, jejunum, ileum, and
colon. Cytologic examination of a fine
needle aspirate of one of the abdominal
lymph nodes revealed intracellular yeast
organisms consistent with Histoplasma
capsulatum (179).
1 What other differential diagnoses should have been considered in this dog
before the results of cytology were available?
2 What is the normal geographic distribution of Histoplasma capsulatum?
3 What are the anatomic sites of predilection of Histoplasma capsulatum in dogs?
4 How could the success of antifungal drug therapy be monitored in this dog?
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Questions
CASE 180 A 2-year-old recently neutered female Sighthound was evaluated for
a several-month history of lethargy and difficulty walking up stairs. The dog had
been adopted by the owners 1 year ago from an animal shelter in Romania and
now lived in Munich, Germany. Since that time, the dog had not travelled outside
of Germany. She had received a vaccination series at the time of adoption and
received tick and flea preventives regularly.
General physical examination revealed an elevated rectal body temperature
(39.2°C [102.6°F]), but was otherwise unremarkable. Neurologic examination
showed kyphosis, low carriage of the neck, and pelvic limb proprioceptive deficits.
The dog exhibited pain when the neck was manipulated and pain was also evident
on palpation of multiple regions of the lumbar and thoracic vertebrae.
Radiographs of the cervical and thoracolumbar spine were obtained (180a, 180b).
180a
180b
1 What are the main differential diagnoses for this dog’s neurologic abnormalities
based on the physical and neurologic examination findings?
2 How would you interpret the radiographs?
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Questions

Rottweiler was evaluated because of
multifocal alopecia and mild pruritus.
The dog had been treated with an
immunosuppressive dose of prednisone
and azathioprine for the last 6 months
because of severe inflammatory bowel
disease. The skin problems had begun
about 3 weeks previously on the dog’s face
and were progressively worsening. The dog
lived in a rural area near Taormina, Italy.
He had been vaccinated against rabies but
not against other infections and the last
time a parasiticide was administered was
about 2 years previously.
Physical examination revealed a multifocal alopecic dermatitis with well-defined
margins, scaling, and some crusting (181). Otherwise the physical examination
was unremarkable.
1 What are the main differential diagnoses for the skin changes in this dog?
CASE 182 Case 182 is the same dog as case 181. Deep skin scrapings were
negative and a few extracellular cocci were found in impression cytology of the
crusts. Leishmania spp. antibody testing was negative. A Wood’s lamp evaluation
and trichogram were also negative. Dermatophytes grew on Sabouraud agar, and
the geophilic fungus Microsporum gypseum was identified (182a, 182b).
182a 182b
1 What are the therapeutic options?

2 What should be done to reduce contamination of the environment?
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Questions
CASE 183 A 5-year-old intact male Belgian Shepherd from San Diego, California,
USA, was evaluated for progressive lethargy, inappetence, vomiting, and diarrhea
for 5 days. The owner reported two generalized seizures on the day of the
presentation. The dog had not been vaccinated for several years and did not receive
ectoparasite or heartworm preventives.
Physical examination revealed stuporous mentation, a rectal temperature of
40.5°C (104.9°F), severe dehydration, a capillary refill time of 3 seconds, white
mucous membranes with petechiation, tachycardia, tachypnea, and tick infestation.
Despite appropriate emergency therapy, the dog developed acute respiratory distress
and ventricular tachycardia and died. Initial bloodwork revealed a hematocrit
of 0.9 l/l (RI 0.40–0.55 l/l%), total protein of 50 g/l (RI 55–75 g/l), 0.14 × 109
WBC/l (RI 6–17 × 109/l), and 5.96 × 109 platelets/l (RI 150–400 × 109/l). Necropsy
and histopathology were performed. The results of necropsy and histopathology
(hematoxylin and eosin stain) of the heart are shown (183a, 183b, 183c).
183a 183b
183c
1 What are the most important findings
of the necropsy and histopathology
of the heart?
2 What are the differential diagnoses
for these abnormalities in this case?
119
Questions
184 CASE 184 A 6-month-old

Poodle was evaluated for severe
acute pruritus for the last 2 weeks.
The dog had severe crusting and
erythema on the pinnae, face,
elbows, tarsi, and ventrum. During
the last week, the owner had also
developed pruritus. The dog lived
in Munich, Germany, and had
received its initial vaccination
series. He had been treated for
endoparasites several times.
Physical examination was
otherwise unremarkable.
Superficial skin scrapings from
185 several large areas of the dog’s
body revealed scabies mites (184).
1 How would you treat the dog?

2
How would you treat the
owner?
3 How would you treat the
environment?
CASE 185 A 6-year-old

neutered male Labrador
Retriever had been rescued in
Spain 2 years ago. A history
prior to the rescue was not
available. Since that time, the
dog had never left Germany (it
now lived in Munich), and was appropriately vaccinated and treated regularly
for ectoparasites and endoparasites. The dog had not had any known health
problems until 8 weeks previously, when alopecia and scaling developed on
both ear tips without any evidence of pruritus (185).
At the time of evaluation, the physical examination was normal besides the skin
lesions and being slightly thin (BCS 3/9). A CBC, serum biochemistry panel, and
urinalysis were all normal.
1 What are your differential diagnoses for the skin lesions?

2 What tests are indicated in this dog?
3 What is the prognosis for each of the major differential diagnoses?
120
Questions
CASE 186 A 4-year-old neutered male mixed-breed dog was referred for
treatment of acute kidney injury due to leptospirosis. The dog had been anorexic
for the last 5 days, but had no vomiting. He had been treated with maropitant,
a metoclopramide continuous rate infusion, and famotidine at adequate doses.
The dog lived in Ingolstadt, Germany, and had not traveled outside the country.
He had only been vaccinated as a puppy and had not received any parasite
prevention or treatment within the last 2 years.
On physical examination, the dog was obtunded. Ulceration and necrosis of
the tongue were present (186a, 186b). The dog exhibited signs of pain when the
kidneys were palpated. The rest of the physical examination was unremarkable.
186a 186b
1 What would be an adequate analgesia protocol for painful oral ulceration?

2 What would be appropriate routes for food administration in this dog?
CASE 187 A 2-year-old intact male Smooth-coated 187

Fox Terrier was evaluated for a 3-day history of
hematuria. The dog lived in Napoli, Italy, and was
owned by a breeder. The dog had been mated with
bitches from several European countries. He had been
vaccinated on a regular basis (distemper, adenovirus,
parvovirus, Leptospira, and rabies) and was on
heartworm prophylaxis.
Physical examination revealed a BCS of 3/9 and a mild
enlargement of the popliteal lymph nodes. Examination
of the prepuce and penile mucosa showed a congested
proliferative lesion around the urethral orifice (187).
1 What are the main differential diagnoses for the

genital lesion?
121
Questions
CASE 188 A 3-year-old intact male Labrador Retriever mix was presented for
booster vaccination. The dog lived in Warsaw, Poland. He had been treated for
endoparasites 1 week before presentation. The dog’s vaccination history was as
follows (see below).
Age Vaccination
6 weeks Attenuated live canine distemper virus (CDV) and canine parvovirus (CPV)
9 weeks Attenuated live CDV, CPV, and canine adenovirus 2 (CAV-2); Leptospira
bacterins (Canicola and Icterohaemorrhagiae)
13 weeks Attenuated live CDV, CPV, and CAV-2; Leptospira bacterins
(Canicola and Icterohaemorrhagiae), inactivated rabies virus
1 year Attenuated live CDV, CPV, and CAV-2; Leptospira bacterins
2 years Attenuated live CDV, CPV, and CAV-2; Leptospira bacterins
At evaluation, the dog appeared

188 clinically healthy. The same combination
of vaccine antigens given at the 2-year
visit was administered. About 25
minutes after vaccination, the owner
noticed swelling around the dog’s eyes
and returned to the veterinarian.
On physical examination, non-
painful periocular edema was evident
(188). There were no signs of upper
or lower respiratory involvement. The
dog’s temperature, heart rate, and
capillary refill time were normal, and
there was no evidence of abdominal pain
or signs of anaphylactic shock. Thus, a
diagnosis of angioedema secondary to
vaccination was made.

2 Is this dog at higher risk for allergic reactions after future vaccinations?
3 How should this dog be vaccinated in the future?
122
Questions
CASE 189 A 6-year-old intact male Pointer mix was evaluated for a 4-week
history of progressive cloudiness in the right eye. Additionally, the dog had
exfoliative skin lesions around his head and ear pinnae, and had appeared to be
debilitated with decreased activity levels for about 4 weeks prior to the onset of the
ocular and skin signs. The owner lived in a suburb of London, UK, and travelled
with the dog to Spain during the summer months, where they spent several weeks
in the coastal area of Malaga.
On physical examination, in addition to the skin lesions, the right mandibular
lymph node was slightly enlarged. Otherwise, physical examination was
unremarkable. On ophthalmic examination of the right eye (189), the conjunctiva
was very hyperemic with markedly injected episcleral vessels. There was
increased tearing and mucoid discharge. The lower eyelid appeared slightly
swollen and mildly hyperemic. There was an absent menace response. Slit lamp
examination revealed diffuse and deep corneal edema; no details of the anterior
chamber could be visualized. The fluorescein test was negative in this eye. The left
eye had very mild perilimbal corneal edema in the dorsal aspect, but was otherwise
normal.

Menace response Absent Present
Pupillary light reflex No visibility of pupil Direct and indirect present
189
1 What is the ocular diagnosis based on the clinical presentation and ocular
examination?
2 Which underlying disease would you suspect based on the clinical findings and
history?
3 What further diagnostic tests do you suggest?
4 What is your ocular and systemic treatment plan for this dog?
123
Questions
190a CASE 190 A 2-year-old intact male

Border Collie mix was evaluated for
lethargy, anorexia, and weakness that
had lasted a week. The owners had
noticed a yellow tinge to the dog’s sclera
over the last 3 days (190a). The dog
had three episodes of vomiting over the
2 days before presentation. The vomit
was described as yellow and watery.
No diarrhea, polyuria, polydipsia, cough
or neurologic signs were reported. The
dog had no previous disease history and
no travel history. It lived in Salvador,
Brazil. The dog had unsupervised outdoor access. Ticks and fleas were infrequently
found on the dog, after which the owners applied topical fipronil. The dog was up to
date on vaccinations against rabies, parvovirus, and distemper.
Physical examination revealed 5–7% dehydration, icterus (190b, 190c), a rectal
temperature of 39.8°C (103.6°F), splenomegaly, and abdominal pain.
190b 190c
1 What are the differential diagnoses for the main problem in this dog?
3 Does this patient represent a risk for transmission of infection to other dogs and
to humans?
CASE 191 Case 191 is the same dog as case 190. Laboratory tests showed
regenerative anemia (hematocrit: 0.28 l/l, RI 0.40–0.55 l/l), thrombocytopenia (63.3
× 109 platelets/l, RI 150–400 × 109/l), normal WBC count, hyperbilirubinemia (total
bilirubin 29.1 µmol/l, RI 0–13.7 µmol/l), normal activity of serum liver enzymes,
and a positive Coombs test. A blood smear was evaluated (191). Antibodies against
124
Questions
Leptospira spp. serovars Autumnalis, 191
Bratislava, Canicola, Grippotyphosa,
Icterohaemorrhagiae, and Pomona were
undetectable, as was a Leptospira PCR
on blood and urine specimens.
1 What are the abnormalities seen on

the blood smear?
2 How did this dog become infected
with these organisms?
3 How should this disease be treated?
CASE 192 A healthy 4-year-old 192

neutered male mixed-breed dog (192)
was evaluated for lameness. The owner
was a hobby hunter and had recently
been diagnosed with Lyme disease.
Four weeks previously, the dog had
an episode of mild lameness in the left
pelvic limb, after a 10-hour mountain
hiking tour in the German Alps, that
lasted for 10 days and then resolved
without treatment. During this episode,
the dog was eating well and did not
show any other signs of illness. The
owner was now concerned that the dog
also could have Lyme disease. The
dog lived in Munich, Germany, and
frequently went hiking with the owner
in the German or Austrian Alps, but he had never been to Southern or Eastern
European countries. The owner also took the dog frequently on hunting trips. The
dog had only been vaccinated regularly against rabies and was not on any ecto- or
endoparasite control. The owner reported that he removed a tick from the dog
about once a month during the summer months.
Physical examination revealed no abnormalities.
1 What is Lyme disease, and how is it transmitted?

2 How common are clinical signs in dogs?
3 Is it possible that the infection was transmitted from the dog to the owner?
4 How could you quickly rule out a diagnosis of Lyme disease in this dog?
125
Questions
193 CASE 193 A 1.5-year-old intact

female Dachshund was evaluated for
a 3-day history of lethargy, anorexia,
and diarrhea. On the day of evaluation
the owner had also noted yellow
coloration of the skin (193). The dog
lived with three other Dachshunds
in a suburban area close to Prague,
Czech Republic, near a waste recycling
facility, where the dog was known to
catch and eat rodents. The dog had
been vaccinated as a puppy twice for
distemper, parvovirus, and adenovirus hepatitis, and later against rabies. She had
not been treated with antiparasitic drugs on a regular basis.
On physical examination, dehydration, icterus, and petechial hemorrhages
on mucous membranes were noted. The cranial abdomen was painful on
palpation. Laboratory findings were consistent with renal failure. In addition,
thrombocytopenia and increased liver enzymes were noted. Antibody titers
against Leptospira serogroups Canicola, Icterohaemorrhagiae, Grippotyphosa,
and Australis were determined by the microscopic agglutination test (MAT). The
titer to Icterohaemorrhagiae was high at 1:6,400, with low (1:100) or negative
titers to other serovars. A urine PCR for Leptospira spp. was positive.
1 What treatment is indicated for leptospirosis?

2 Are other dogs in this household at risk of infection?
3 Could handling this dog represent a risk for humans?
CASE 194 A 2-year-old intact male Labrador Retriever was evaluated for a very
cloudy left eye, which the owner had first noticed about 3–4 days previously. The
dog lived with one other dog and two cats in the countryside near London, UK,
and there was no travel history. The dog was regularly vaccinated, treated for
endoparasites, and received preventives for ectoparasites. There was no history of
previous ocular disease or other illnesses.
Physical examination was unremarkable besides the ocular changes. On ocular
examination of the left eye, there was diffuse, subtle corneal edema, diffuse
conjunctival hyperemia, mild chemosis, and mild to moderate mucoid discharge
(194). Slit lamp examination of the anterior chamber revealed aqueous flare
++/++++ (positive Tyndall effect) and traces of hyphema. The iris was diffusely
swollen and hyperemic (rubeosis iridis), with the pupil being miotic. The lens was
clear. Examination of the posterior segment was limited because of the aqueous
126
Questions
flare and miotic pupil, but no gross 194
lesions were detected. However, the
tapetum appeared to have multifocal
“dull looking” (hyporeflective) areas in
the dorsal aspect.
Ophthalmic Right eye Left eye

examination (OD) (OS)
Menace response Present Decreased
Pupillary light reflex Normal Pupil miotic
1 Based on the ophthalmic findings in the left eye, what is your ocular diagnosis?
2 What ocular treatment would you suggest?
3 What further diagnostic tests would you perform to identify the underlying
etiology?
CASE 195 A 2-year-old Labrador 195

Retriever was evaluated for numerous
skin lesions (195). The dog was pruritic
predominantly on the ventrum, inguinal
area, flanks, thighs, and dorsal trunk.
Otherwise, the dog was bright and alert.
The dog lived in Munich, Germany, and
was regularly vaccinated and treated
for endoparasites, but was not on any
ectoparasite control.
showed no other clinical abnormalities
besides the pruritus and skin lesions. An
impression smear revealed numerous
cocci and occasional neutrophils with engulfed bacteria.
1 What is the most likely underlying cause for the pyoderma?

3 Does the treatment have consequences for any tests used to identify underlying
disease?
127
Questions

mixed-breed dog (196) was evaluated at a
wellness visit. The dog had been diagnosed
with immune-mediated thrombocytopenia
at the age of 2 years. The disease was
well controlled with treatment and the
dog was currently receiving a low dose of
prednisolone and azathioprine. The dog
lived in downtown Munich, Germany, and
had never been outside the country. The dog
was never allowed to run free and had not
much contact with other dogs. The owner’s
neighbor (from an apartment on the same
floor of the apartment building) had recently
purchased a puppy from the internet, and
the puppy had died of parvovirosis 1 week
previously. The owner was concerned that the dog could also get parvovirosis
and asked for advice on whether to vaccinate the dog or not. The dog had been
vaccinated against parvovirus infection at the age of 8 weeks, 12 weeks, and
16 weeks, and 12 months later, but never since. The dog had not received preventive
treatment for endoparasites or ectoparasites within the last 2 years.
Physical examination was unremarkable. A CBC revealed no abnormalities, and
the platelets were in the RI.
1 What would be your assessment of the vaccination history of this dog?

2 Could vaccination against parvovirus infection present an increased risk of
adverse effects for this dog?
3 What would you recommend as an alternative to vaccination?
CASE 197 A 6-year-old neutered female German Shepherd Dog from Sacramento,
California, USA was evaluated for inappetence, weight loss, and lethargy. Five
months previously, the owner had noted pelvic limb lameness that did not respond
to carprofen. Subsequently the dog developed inappetence and transient small
bowel diarrhea, and began to lose weight. Water consumption and urination were
normal to slightly decreased. There was no history of trauma, toxin exposure, or
ticks. The dog had no travel history, was last vaccinated 4 years ago, and had not
received any preventive treatments for parasites for at least 1 year.
On physical examination, the dog was quiet, dull, mildly dehydrated, and thin
(BCS 2/9). Although ambulatory, the dog had a stilted gait and appeared mildly
ataxic. A neurologic examination showed placing deficits in both pelvic limbs.
128
Questions
The dog exhibited pain when her tail 197
was raised and also on palpation of the
lumbosacral region and mid-thoracic
spine. All other physical examination
findings were normal. A CBC was
unremarkable. A chemistry panel
showed severe azotemia (creatinine
760.3 µmol/l [RI 50–119 µmol/l], BUN
58.2 mmol/l [2.6–9.9 mmol/l]) and
hyperglobulinemia (47 g/l). Urinalysis
showed a specific gravity of 1.011,
0.75 g/l of protein, pH 6, and >100
WBC and >100 RBC/hpf. Urine culture
revealed large numbers of Aspergillus terreus (197).
1 What is the significance of finding Aspergillus terreus in this dog’s urine?

2 What is the likely cause of the pelvic limb paresis?
3 Had the urine culture been negative, what additional test could have been
performed to make a diagnosis?
4 What treatment would be recommended, and what is the prognosis?
CASE 198 An 8-month-old intact female American Pitbull Terrier was evaluated
for acute anorexia, severe lethargy, and high fever (temperature 40.2°C [104.4°F]).
The owners lived in Rome, Italy, but had recently been on a trip to Croatia with
the dog. The dog was up to date on core vaccinations (distemper, adenovirus,
parvovirus, rabies, Leptospira), but had not received prophylaxis for internal or
external parasites.
On physical examination, the dog 198
had very pale mucous membranes,
icteric sclera, and a weak pulse, and an
arrhythmia was detected on auscultation
of the heart. A CBC and biochemistry
profile showed severe anemia (0.12 l/l,
RI 0.37–0.55 l/l), autoagglutination,
and mild thrombocytopenia (100 × 109
platelets/l, RI 150–400 × 109/l). Blood
smears were obtained (198).

129
Questions
CASE 199 An adult intact male mixed-breed dog was rescued from the streets
in San Diego, California, USA, and taken to a local humane society, where he was
found to have severe tick infestation (199a) and blindness.
Physical examination revealed a BCS of 2/9, normal vital signs, pale mucous
membranes, lymphadenopathy, and splenomegaly. There was no menace response
or dazzle reflex bilaterally. Pupillary light reflex was also absent, and both pupils
were fixed and dilated (199b). Scleral injection was present in both eyes, and was
most severe in the left eye. Palpebral and corneal reflexes were normal bilaterally,
and a Schirmer tear test was normal in both eyes. Intraocular pressure (IOP) was
9 mmHg in the right eye and 10 mmHg in the left eye (RI 12–25 mmHg).
199a 199b
1 What are the clinically relevant findings from the ophthalmic examination?
2 What are the most likely diseases causing these problems?
CASE 200 A 2.5-month-old intact male Polish Tatra Sheepdog was presented
for its first vaccination. The puppy had been recently treated for endoparasites. It
had come from a breeder in Warsaw, Poland, and now lived in a rural area close to
Warsaw. On physical examination the puppy appeared healthy. A vaccine containing
live attenuated canine distemper virus, canine parvovirus 2, canine adenovirus,
and two inactivated Leptospira serovars (Canicola and Icterohaemorrhagiae) was
administered subcutaneously.
Within 15 minutes after administration of the vaccine, the puppy developed
edema on the nose and around the eyes (200) and ptyalism, followed almost
immediately afterwards by an episode of vomiting, marked abdominal pain,
diarrhea with hematochezia, urination, tachypnea, bradycardia, and cyanotic
mucous membranes. These clinical signs were suggestive of anaphylactic shock.
130
Questions
1 Given that this puppy has never been 200
vaccinated before, could the vaccine
be the cause of the anaphylactic
shock?
2 How common is postvaccinal ana-
phylaxis in dogs?

Boxer dog (201) was referred for
progressive neurologic abnormalities.
The dog had been ataxic over the last
7 days, and 5 days previously circling
had been observed. Over the past 4 days,
the dog had been non-ambulatory.
A veterinarian had treated the dog
with prednisolone, chloramphenicol,
and diazepam, but this did not lead
to any improvement. The dog lived
in Freiburg, Germany, and had not
traveled outside the country. He had only been vaccinated in his first year of life,
and had only received endoparasite and ectoparasite treatment as a puppy. The
owner reported that the dog had frequent tick infestations, but he always removed
the ticks immediately because the dog had a short hair coat.
On physical examination, the dog presented in lateral recumbency and was
unable to stand or walk; he had a reduced menace response bilaterally. Voluntary
movement of the thoracic limbs was present, but this was absent in the pelvic
limbs. The dog also had bilateral mydriasis.
A CSF analysis revealed a high WBC count and a moderate CSF protein
concentration. The CSF was positive for tick-borne encephalitis virus by PCR.
1 What is tick-borne encephalitis?

2 What are the typical clinical signs?
131

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What are the clinically relevant findings from the ophthalmic examination of the dog in CASE 199?

What are the clinically relevant findings from the ophthalmic examination of the dog in CASE 199?

What are the most likely diseases causing the problems in the dog in CASE 199?

What are the most likely diseases causing the problems in the dog in CASE 199?

Self-Assessment Color Review

Canine Infectious Diseases

Conversion factors.................................................................................... 265

Katrin Hartmann and Jane Sykes

Ralf S. Mueller Stefan Unterer

Fungal/algal infections Vaccination

Complete blood count Results Reference interval

Biochemistry panel Results Reference interval

1 How would you interpret the findings in this dog?

1 How would you make a specific diagnosis of leptospirosis?

3 CASE 3 A 6-month-old intact male

1 What are the differential diagnoses for draining skin lesions?

1 What is the differential diagnosis for icterus?

CASE 7 Case 7 is the same dog as case 6. A CBC revealed a hematocrit of

9 CASE 9 A 4-year-old intact female

Complete blood count Results Reference interval

Biochemistry panel Results Reference interval

1 Which infectious agents can be transmitted by Rhipicephalus sanguineus?

CASE 11 A 10-month-old neutered 11

1 What is the neuroanatomic localization of the problem?

15 CASE 15 Case 15 is the same dog as case 14.

1 Would you proceed with the dental cleaning procedure?

1 Describe the blood smear findings.

18 CASE 18 A 6-year-old intact male

1 How would you interpret the gastroscopy picture?

1 How would you interpret the results?

22 CASE 22 A 4-year-old intact male mixed-

1 What is the likely etiology of the clinical signs?

23 CASE 23 Case 23 is the same dog as case

1 How would you describe the radiographic findings?

CASE 24 A 3-year-old intact female Miniature Schnauzer was evaluated for

1 Why is the presence of CNS 24

25a CASE 25 A 4-year-old neutered female

1 What is your interpretation of the radiographs?

1 What findings can be seen on bronchoscopy and on cytologic examination of

CASE 27 A 10-year-old neutered 27

1 What can be seen in the urinary sediment?

28 CASE 28 A 2-year-old intact male

1 What are the differential diagnoses for the petechial lesions?

1 What is the diagnosis?

CASE 31 Case 31 is the same dog as 31

1 If no parasites can be found on a

32 CASE 32 A 7-year-old neutered male

CASE 33 Case 33 is the same dog as 33b

1 What is your interpretation of the radiographs?

CASE 34 Case 34 is the same dog as in cases 32 and 33. Echocardiography

1 What is your interpretation of the echocardiographic examination?

1 What is the diagnosis?

1 What treatment is recommended?

1 How common is canine herpesvirus

38 CASE 38 An 11-year-old neutered

Complete blood count Results Reference interval

Biochemistry panel Results Reference interval

Urinalysis Results Reference interval

CASE 39 A 4-year-old neutered 39

44 1 What are the possible differential