Pulmonary Alveolar Proteinosis in a Dog

Abstract

A 3½-year-old male Shih Tzu dog was examined by a referring veterinarian at the University of Georgia Veterinary Medical Teaching Hospital, Athens, GA, for chronic exercise intolerance since 6 months of age and coughing of 4 months' duration. The dog's medical history included mild seborrhea sicca and seasonal atopic dermatitis, treated with dietary modification and parenteral triamcinolone injections every 2-3 months. The dog had been treated with a 2-week course of tetracycline (15 mg/kg PO q8h) 3 months before examination for lethargy, fever, and weakness in conjunction with high serum immunoglobulin G titers to Borrelia burgdorferi (1,024; reference range, Ͻ256) and Rickettsia rickettsii (128; reference range, Ͻ64). The dog also received amoxicillin and clavulanate (20 mg/ kg PO q12h) for 10 days 4 months before referral and enrofloxacin (5 mg/kg, PO q12h) for 10 days 7 weeks before referral. No improvement was seen with any of these therapies. Hematologic abnormalities present during this time included a persistent neutrophilic leukocytosis with an inconsistent lymphocytosis and eosinophilia.At the time of referral, examination revealed the dog to be bright, alert, and responsive. Rectal temperature was slightly high (102.8ЊF [39.3ЊC]; reference range, 99.5-102.5ЊF [37.5-39.2ЊC]). The dog had a normal pulse rate (130 beats/min; reference range, 110-130 beats/min) and increases in respiratory rate (50 breaths/min; reference range, 15-30 breaths/min). Lung sounds were increased in intensity, and the dog had an easily induced dry, hacking cough.Abnormalities on hematologic testing included a leukocytosis (23.4 ϫ 10 3 cells/L; reference range, 5.1-13.0 cells/L) with a mature neutrophilia (18.3 ϫ 10 3 cells/L; reference range, 2.9-12.0 cells/L) and eosinophilia (2.1 ϫ 10 3 cells/L; reference range, 0.0-1.3 cells/L). Serum total protein (7.6 g/dL; reference range, 5.4-7.5 g/dL) and globulin concentrations (4.2 g/dL; reference range, 1.9-5.3 g/dL) were increased. Urinalysis was within normal limits. Fundic examination revealed no abnormalities. An interstitial lung pattern was seen on thoracic radiographs ( Fig 1A,B). No parasite ova were seen in feces examined by Sheather flotation or Baermann extraction. Cytologic findings of a transtracheal washing were of a moderate amount

ACVIM consensus statement guidelines for the diagnosis, classification, treatment, and monitoring of pulmonary hypertension in dogs

“…Dogs with cryptogenic organizing pneumonia receiving early and aggressive treatment with immunosuppressive doses of glucocorticoids may have a good prognosis . Whole lung lavage has been described to treat pulmonary alveolar proteinosis . Corticosteroids are the primary treatment for eosinophilic lung disease …”

“…94 Whole lung lavage has been described to treat pulmonary alveolar proteinosis. 193 Corticosteroids are the primary treatment for eosinophilic lung disease. 95,185,186 b.…”

Imaging Diagnosis—pulmonary Alveolar Proteinosis in a Dog

“…The first reported canine patient with pulmonary alveolar proteinosis (a 1‐year‐old Cocker Spaniel) was lethargic and suffered from exercise intolerance and a fever . The second canine case involved a 3.5‐year‐old, male Shih Tzu with a 4‐month history of cough and a 3‐year history of exercise intolerance . The dog in this report had no cough but was severely dyspneic and had exercise intolerance.…”

“…Pulmonary alveolar proteinosis (PAP) is a rare condition in humans that was initially described in 1958 . Although pulmonary alveolar proteinosis has only been reported in two dogs, it is considered one of the differential diagnoses for canine interstitial lung disease. The disease occurs when phospholipoproteinaceous material accumulates in alveoli, resulting in impaired gas exchange and a restrictive breathing pattern .…”

Respiratory Tract

“…This is an uncommon condition with prominent cytologic findings in lung aspirates or BAL (Silverstein et al, 2000). Dogs present with a chronic history of exercise intolerance and coughing.…”