Inflammatory Bowel Disease Associated with Lymphangiectasia in a Dachshund Dog

Abstract

Background: Inflammatory bowel disease (IBD) is a chronic enteropathy that causes gastrointestinal disorders in dogs and cats. It can result in protein loss generally when it is a lymphoplasmacytic enteritis type. In this case, it is frequently associated with lymphangiectasia. Clinical signs include diarrhea, vomiting and progressive weight loss. This disease mainly affects middle-aged animals. There is only one report in young dog and no reports were observed in Dachshund breed. The objective of this article is reporting the association of inflammatory bowel disease and lymphangiectasia in a young Dachshund bitch.

Case: It was attended a 2-year-old Dachshund bitch, weighing 7.5 kg. The animal presented with a history of diarrhea, vomiting, weight loss and hyporexia. In the physical examination, it was detected capillary refill time greater than 2 s, dehydration of 5 to 6%, muffled pulmonary auscultation on both sides of the thorax (suggesting pleural effusion), abdominal pain, flatulence and a positive balloon test (suggesting ascites). Thoracocentesis and abdominocentesis were performed to drain the pleural effusion and ascites, respectively. Both fluids were classified as transudate. The blood count resulted in normocytic normochromic anemia, neutrophilic leukocytosis, eosinopenia, lymphopenia, monocytosis and thrombocytosis. Serum biochemistry findings included hyponatremia, hypochloremia, hypocalcemia, hypocholesterolemia, hypoproteinemia, hypoalbuminemia, hypoglobulinemia and increased alkaline phosphatase. Abdominal ultrasonography showed thickening of the duodenal wall, some segments with hyperechogenic streaks in the jejunal mucosa, colon with increased parietal thickness and presence of free peritoneal fluid. The histopathological analysis of intestinal and gastric fragments, obtained by surgical biopsy, confirmed the diagnosis of lymphoplasmacytic IBD associated with lymphangiectasia. It was classified as severe according to the canine inflammatory bowel disease activity index (CIBDAI). The patient was admitted to hospital and submitted to dietary management, immunosuppressants, antibiotics and supportive therapy. However, the dog has died after 10 weeks.

 Discussion: The prognosis of IBD is highly variable, depends on therapeutic response and extent of intestinal damage. Dietary therapy associated with anti-inflammatories and immunosuppressants may result in IBD remission. This is characterized by periods of improvement that can last from months to years. Although, in more severe cases, some animals do not respond adequately and relapsed. Lymphangiectasia is a common complication of IBD in dogs, resulting in lymph extravasation and protein loss into the intestinal lumen. Those patients may develop protein-calorie depletion, disabling strokes, or intractable diarrhea. Hypoalbuminemia is an unfavorable prognostic marker. Firstly, in this case, the CIBDAI score was severe (14 points). Along treatment, it evolved into a clinically insignificant condition (2 points). However, later, there was regression to clinically severe disease (12 points). The dog did not respond adequately to the therapy, despite the indicated treatment have been instituted. It had continuously effusions, diarrhea and progressed to cachexia. Hypoproteinemia probably contributed to the severity of the clinical condition and therapeutic response failure, resulting in the animal's death at 10 weeks from the 1^st appointment.

Keywords: lymphangiectasis, gastrointestinal, inflammation, lymphatic system, diarrhea, hypoproteinemia, CIBDAI.

Título: Doença intestinal inflamatória associada com linfangiectasia em um cão Dachshund

Descritores: gastrointestinal, inflamação, sistema linfático, diarreia, hipoproteinemia, CIBDAI.