Clinical Case Challenge

A 9-year-old intact male Labrador retriever presented to Tufts Foster Hospital for Small Animals for further evaluation of history of painful gait, chronic atopic dermatitis/pododermatitis (for years) and the recent discovery of of increased liver enzymes (ALT =422 U/L, ALP= 377 U/L, AST =73 U/L) with a normal albumin and bilirubin. The dog had failed to respond to consecutive 3 week courses of clindamycin and cefpodoxime. On physical examination the dog was normal except for extreme difficulty in getting up and walked gingerly. He would not permit full examination of the feet, but a moist dermatitis and areas of ulceration were appreciated (Fig 2 A).

Fig 2

Fig 2. Hepatocutaneous syndrome in a dog. A. Gross appearance of feet with hyperkeratosis and ulceration. B. Ultrasound of liver showing typical ‘honeycomb’ pattern consisting of variable-sized hypoechoic regions surrounded by hyperechoic borders. B. Skin biopsy (H&E) with 1: Marked parakeratotic hyperkeratosis; 2: Vacuolar change in the upper levels of the epidermis; 3. Hyperplastic epidermis with acanthosis. Images A and C courtesy of Dr Lluis Ferrer and B from Dr. Dominique Penninck.

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Clinical Case Challenge

Clinical case challenge

History:

A 5-year-old sprayed female domestic short haired cat is brought to her veterinarian for evaluation of raised pink lesions on the medial thighs of 2 weeks duration.  The owners report that she is a healthy cat that lives indoors but occasionally has access to a screened porch.  There are no other cats in the household.  She is up-to-date on her vaccines and is fed a high quality, nutritionally balanced, commercial diet. Continue reading

Clinical Case Challenge

Maxy, a 2-year-old spayed female Golden Retriever, presents for her first weigh in after starting a weight loss program. Her initial physical exam reveals no abnormalities other than a body condition score of 9/9 (normal muscle condition). Her starting weight is 105 pounds, with an estimated ideal weight of 80 pounds. Her diet history reveals that she was receiving 2000 kcal from her current diet. You start her on 1600 kcal of a therapeutic diet after calculating that this is 80% of her current estimated caloric intake. After two weeks on the veterinary therapeutic diet, the owner is upset that Maxy has gained one-half pound and is now 105.5 lbs. Continue reading

Clinical Case Challenge

History

An 8 year-old spayed female Golden Retriever was referred to the Foster Hospital for Small Animals with a three-week history of right forelimb lameness. On physical examination the dog would not bear weight on the affected leg when standing and a toe touching lameness was present when walking. Pain was elicited with light palpation of the right proximal humerus. Initial forelimb radiographs from the referring veterinarian were considered within normal limits. Given the persistent and progressive lameness, follow-up radiographs of the right forelimb were obtained. Continue reading