Presumed lupus erythematosus cells identified in bronchoalveolar lavage fluid from a Mexican Hairless dog

Abstract

A neutered male Mexican Hairless dog was presented for generalized weight loss and weakness. Initial laboratory testing and diagnostic imaging revealed thrombocytopenia and an interstitial to miliary lung pattern affecting all lung fields. Mild joint effusion was found on physical examination affecting the stifle, tarsal, carpal, and elbow joints. Examination of synovial fluid demonstrated an inflammatory polyarthropathy in 3 joints. Cytocentrifuged and direct preparations of the bronchoalveolar lavage (BAL) fluid sample were made and cells consistent with lupus erythematosus (LE) cells and ragocytes were found. Based on these findings, the anti-nuclear antibody (ANA) titer was determined as 1:640. A clinical diagnosis of systemic LE was made based on the satisfaction of 2 major criteria (thrombocytopenia and inflammatory polyarthritis), 4 minor criteria (central nervous system signs, lymphadenopathy, fever of unknown origin, and pleuritis), positive ANA titer, and the identification of presumed LE cells in BAL fluid. This case report highlights a novel finding of LE cells in respiratory secretions and provides a review of diagnostic criteria of systemic LE.

New findings associated with presumptive systemic lupus erythematosus in a kitten

“…One dog had a multifocal structured interstitial to miliary pattern affecting all lung fields on chest radiographs, and a cytology of bronchoalveolar lavage revealed the presence of a lupus erythematosus cell. 38 On the second dog, a moderate generalized pulmonary interstitial pattern on thoracic radiographs was observed. Lung necropsy revealed general inflammatory infiltration with an interstitial, diffuse, subacute-to-chronic pneumonitis, a chronic peri-bronchiolitis and a chronic peribronchitis.…”

Diagnosis of systemic lupus erythematosus in a dog with an atypical presentation of pleuritis

“…8,10,11 Similarly, LE cells are an uncommon finding in domestic species; they are rarely observed in synovial fluid, 5 and have been reported in the BAL of a dog. 12 While the diagnosis of SLE remains challenging due to its non-specific manifestation, this case report illustrates the insidious nature of SLE as 'the great imitator' of other diseases. We also report for the first time the presence of LE cells in the pleural fluid of a dog, which highlights the importance of careful cytological evaluation of serous fluid to provide clues for the diagnosis.…”

“…In people, they have been described in synovial fluid, body cavity effusions, bone marrow, peripheral blood, bronchoalveolar lavage (BAL) and cerebrospinal fluid 8,10,11 . Similarly, LE cells are an uncommon finding in domestic species; they are rarely observed in synovial fluid, 5 and have been reported in the BAL of a dog 12 …”

Erosive and ulcerative stomatitis in dogs and cats: which immune-mediated diseases to consider?

“…In veterinary medicine, more than 1 unvalidated criterion can be found. 33,34 In the most recent publication, at least 2 major signs with positive ANA test or at least 1 major and 2 minor signs with positive ANA test were required. 33 One must remember that positive ANA has been demonstrated in dogs with Leishmania, Bartonella, and Ehrlichia infections, with other autoimmune/immune-mediated conditions, or even in healthy dogs.…”

“…33,34 In the most recent publication, at least 2 major signs with positive ANA test or at least 1 major and 2 minor signs with positive ANA test were required. 33 One must remember that positive ANA has been demonstrated in dogs with Leishmania, Bartonella, and Ehrlichia infections, with other autoimmune/immune-mediated conditions, or even in healthy dogs. 35,36 Similarly, positive ANA test results have been reported in about 30% of healthy cats and in cats suffering from FeLV.…”