Diagnostic Challenge Overcome For Eagle The Under Par Whippet
Eagle, a young whippet who was significantly under par with a chronic cough, weight loss and reduced energy, was an interesting diagnostic challenge for the internal medicine team at Davies Veterinary Specialists (Davies) in Hertfordshire. Thanks to persistent investigations and repeat BAL sampling, the dog made a good recovery.
The two-year-old whippet was referred to Linnaeus-owned Davies for further investigations because he had a persistent, chronic cough, was losing weight, had a picky appetite and a rumbling tummy. He was mostly coughing overnight, bringing up phlegm.
Initial investigations (blood tests, CT and ultrasound scans and lung wash), led by Internal Medicine Specialist Polly Frowde, resulted in a suspected diagnosis of an aerodigestive disorder; chronic enteropathy, such as IBD, could be contributing to coughing via gastro-oesophageal reflux or low-grade aspiration.
Pending the results of a bronchoalveolar lavage (BAL), Eagle was prescribed an exclusion diet and medication for reflux/IBD (omeprazole and metoclopramide), together with vitamin B12 for gut support (as his levels were low). He was also given a de-wormer in case Giardia was contributing to loose faeces and to help treat any lungworm present. Although prior lungworm testing had been negative, this did not completely exclude the infection and the changes seen on his chest CT meant this was still a contender. Subsequently, the outcome of the BAL was non-diagnostic and his response to trial treatment was suboptimal, taking the internal medicine team back to the drawing board.
“Although Eagle’s signs initially improved a little on the medication, they did not completely resolve,” said Polly. “He continued to suffer frequent coughing fits and weight loss, so we made the decision to conduct a bronchoscopy to perform a ‘targeted’ BAL. We also discussed combining this with an endoscopy for his possible enteropathy, but it was decided to stage investigations.”
“The bronchoscopy revealed yellow mucus in the airways and mild tracheal collapse. We used a scope for the lung wash for further reach this time (targeting where the main changes were on CT). Initial in-house analysis of the samples showed eosinophilic inflammation – raising suspicion for an immune-mediated form of inflammatory lung disease called eosinophilic bronchopneumopathy. Parasites can also cause this inflammation, but, as he had already been thoroughly wormed, seemed unlikely.”
The final laboratory results confirmed eosinophilic inflammation consistent with eosinophilic bronchopneumopathy. Eagle was prescribed oral steroids (prednisolone) to which he has had an excellent response. These are usually tapered to a ‘maintenance dose’ to prevent disease relapse. Steroid administration via an inhaler was also introduced as sometimes this can be used instead of oral dosing in the longer term, to minimise side effects.
“This was an interesting case given that the initial BAL was non-diagnostic and it was very rewarding to finally get to the bottom of things for poor Eagle,” said Polly. “It highlighted the need for repeat sampling in some patients and the diagnostic dilemmas when faced with possible lungworm infection, since certain procedures such as bronchoscopy can be riskier if the parasite is causing problems with coagulation. A ‘targeted’ lung wash can reach more distant areas of the lung. It is likely that Eagle also has a chronic enteropathy, which may be benefiting from the steroids too.”
“Eagle has made a great recovery since the diagnosis of the inflammatory lung disease,” said his owner Kathryn Stratton. “Initially being treated with oral steroids we saw immediate improvement. We have also been able to successfully taper down the steroids, so that he is now only having steroids administered via an inhaler. It is a huge relief to finally have positive improvement from Eagle. After months of sleepless nights from his consistent coughing and vomiting, he is back to running around, playing and misbehaving!”
To find out more about the internal medicine service at Davies visit https://vetspecialists.co.uk/services/internal-medicine/