Acute Polyarthritis and Septicemia from Mycoplasma edwardii after Surgical Removal of Bilateral Adrenal Tumors in a Dog

Abstract

A 12-year-old spayed female Shetland Sheepdog weighing 11.4 kg was evaluated at the University of Tennessee Veterinary Teaching Hospital for polyuria, polydipsia, and panting. Concurrent problems included atopy and hypothyroidism. Medications included biweekly allergen immunotherapy, a chlorpheniramine b (0.5 mg/kg PO q12h), and levothyroxine c (0.02 mg/kg PO q12h).Physical examination was normal except for indirect systolic blood pressure of 200 mmHg, measured with Doppler. The dog had thrombocytosis with 623,000 platelets/L (reference range, 200,000-500,000/L) and increased alkaline phosphatase (ALP) activity of 237 U/L (reference range, 12-122 U/L). Urine specific gravity was 1.014 with 2ϩ protein, and the urine protein to creatinine ratio was 2.4 (reference range, Ͻ0.5). Aerobic urine culture was negative for bacterial growth.The patient had an exaggerated response to an ACTH stimulation test, with baseline cortisol of 3.4 g/dL (reference range, 1.5-6 g/dL) and poststimulation cortisol of 22.3 g/dL (reference range, 8-16 g/dL). Cortisol also failed to suppress after administration of a low dose of dexamethasone (LDDS), with baseline cortisol of 2.5 g/ dL (reference range, 1.5-6 g/dL), 4-hour cortisol of 1.3 g/dL (reference range, Ͻ1 g/dL), and 8-hour cortisol of 1.5 g/dL (reference range, Ͻ1 g/dL), which was less than 50% suppression of baseline. Endogenous ACTH concentration was low at 2.5 pmol (reference range, 6.7-25 pmol/L). These results were considered consistent with adrenal-dependent hyperadrenocorticism. Sonographic evaluation of the abdomen identified mineralization and enlargement of the right adrenal gland (Ͼ20 mm) and an irregularly enlarged cranial pole of the left adrenal gland (12.5 mm). Differential diagnoses for bilateral adrenal tumors included some combination of functional adrenal adenoma, carcinoma, pheochromocytoma, metastatic neoplasia, or bilateral nodular adrenocortical hyperplasia secondary to pituitary-dependent hyperadrenocorticism (PDH). Despite finding bilateral adrenal tumors sonographically, analysis of the results of a high-dose dexamethasone suppression test (HDDS) revealed baseline cortisol of 2.2 g/dL (reference range, 1.5-6 g/dL), 4-hour cortisol of 1.1 g/dL (reference range, Ͻ1 g/dL), and 8-hour cortisol of 1 g/dL

Comparison of synovial fluid culture and 16S rRNA PCR in dogs with suspected septic arthritis

“…PCR is a rapid molecular diagnostic technique that demonstrates high sensitivity and specificity compared with traditional culture methods . PCR has been shown to be an effective method of identifying organisms from cerebral spinal fluid, blood and cardiac and musculoskeletal tissues in humans and dogs . Given this apparent utility, several studies have investigated the use of PCR for identification of bacteria in synovial fluid from humans, horses and dogs …”

“…[18][19][20][21][22] PCR has been shown to be an effective method of identifying organisms from cerebral spinal fluid, blood and cardiac and musculoskeletal tissues in humans and dogs. 17,18,20,21,[23][24][25][26] Given this apparent utility, several studies have investigated the use of PCR for identification of bacteria in synovial fluid from humans, horses and dogs. 21,26,27 The use of PCR to identify bacteria in synovial fluid from dogs with suspected septic arthritis in a clinical setting has not been reported.…”

Mycoplasma Infections

“…[8][9][10][11][12][13][14][15][16][17][18] Because mycoplasmas are commonly isolated from the upper respiratory and genital tracts of healthy dogs and cats, their role in ocular, upper respiratory tract, and urogenital tract disease has been difficult to determine. Simultaneous colonization with more than one Mycoplasma species is common.…”

Meningoencephalitis Caused by Mycoplasma Edwardii in a Dog

“…8 Mycoplasma edwardii has been associated with pneumonia in early reports 3,13 and was recently isolated from a dog with acute polyarthritis and septicemia, which developed following a surgical procedure. 12 In human beings, Mycoplasma spp. have been associated with development of brain abscesses and meningitis in neonates.…”

“…Although considered a Mycoplasma species of dogs, M. edwardii has also been isolated from the oral and nasal cavities and rectum of wild healthy raccoons in Japan 8 3,13 and was recently isolated from a dog with acute polyarthritis and septicemia, which developed following a surgical procedure 12 …”