PYOMETRA AND SPLENIC TUMOR IN A RESCUED DASCHUND CROSS BITCH

POSITIVE WITH EHRLICHIOSIS AND ANAPLASMOSIS; A CASE REPORT

OVERVIEW
Adopting a rescue dog is a very rewarding experience. Not only are you giving a furry
friend a second chance at a happy life, but you also get to experience the unconditional love and
affection that they have to offer. While all dogs can get sick, rescue dogs may come with a
certain set of health issues due to their previous living conditions. Common health problems
found in rescue dogs include worms, fleas and ticks’ infestation, malnourishment, skin problems,
mental and behavioral problems, bacterial and viral infections as well as the development of
tumors. With these, treatment is necessary to prolong their lives.

CASE PRESENTATION
In November 2023, under the "Adopt a Stray" programme of Dumaguete Animal
Sanctuary, an older stray dog named Lou was rescued. Lou was an abandoned dog being fed by
several people and one of the many female dogs in Dumaguete, Philippines who received a
DEPO injection as contraceptive. One wonderful family who had been feeding her, offered to
adopt. However, Lou's case turned out to be complex. She was found severely anemic when she
was rescued and had pyometra, a septic uterus. Plus 2 tick borne diseases, Ehrlichia and
Anaplasma.

Figure 1: Lou’s blood profile (CBC) upon rescue. November 7, 2023.

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 Figure 2: Lou’s Ultrasonography. Ventrodorsal view of the uterus showing anechoic
bladder; anechoic uterus with a thick uterine wall; and hypoechoic spleen which were enlarged
and covering the proximal part of the uterus.

She wasn't in a fit state for surgery based on her blood profile (showed on Figure 1), but
the pyometra (Figure 2) was advanced and surgery needed to be done asap to save her life. The
attending veterinarian decided to improve first Lou’s blood profile and set it to a safe level for
surgery while treating the blood parasitism (Ehrlichiosis and Anaplasmosis) that she had.

TREATMENT

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 The patient was given IV infusion of Lactated Ringer’s Solution with a flow rate of 1
drop/5 seconds to correct her hydration and give a systemic support. 4.25 mL of Multivitamins
(Duphalyte) bolus were also administered intravenously slowly twice daily. Corticosteroid
Prednisolone (Prednivet) was given orally with a dosage rate of 1mg/kg SID for 3 days, to treat
the ongoing inflammation on the uterus and spleen; and also, to increase platelet count.

Erythropoietin Epoetin Alfa (EPOSINO) was given subcutaneously with a dosage rate of
100 iu/kg 3 times a week for 2 weeks, this is to increase the red blood cell (RBC) count of the
patient. Iron supplement therapy was also included to help and maximize erythropoiesis with a
dosage rate of 10mg/kg intramuscularly every 7 days for 2 weeks.

Ehrlichiosis and Anaplasmosis were treated with Doxycycline tablet with a dosage rate of
10mg/kg and was given twice a day for 35 days. While the pyometra on the uterus was treated
with Metronidazole (Enterovet) with a dosage rate of 50mg/kg twice daily for 7 days, since
pyometra is commonly cause by anaerobic facultative bacterium Escherichia coli, metronidazole
is very effective on this type of bacteria. Note: The two antibiotics were given 3-4 hours after the
iron supplement because of the drug interaction with the said antibiotics (decrease absorption of
antibiotics).

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 Figure 3: Lou’s follow up CBC after 2 weeks. November 21, 2023.

Figure 4: Lou’s follow up CBC after 2 weeks. December 6, 2023.

After a series of blood profiling through CBC, her blood profile improved especially her
white blood cell (WBC) count, got back into its normal ranges which is an indication that her
infection with blood parasitism (Ehrlichiosis and Anaplasmosis) were improving, but her red
blood cell (RBC) profile were just increased slightly. With these, on December 7, 2023, the
veterinarian decided to proceed on the surgery with an initial plan of removing her septic uterus

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(pyometra) by ovariohysterectomy. But when they opened her up, they discovered she had a very
large spleen caused by Ehrlichia and there was a presence of focal infarction in the head part of
the spleen. The spleen was in the way of the uterus and needed removing, so the surgical
procedure was diverted into removing her spleen (splenectomy). The septic uterus was left with a
continuous medication with antibiotic (metronidazole) and was rescheduled just to give recovery
time on the removal of her spleen.

A B

Figure 5: Removal of the spleen (splenectomy). The spleen was enlarged and was comparable to
a pig’s spleen (C). Presence of focal infarcton on the tail part of the spleen was seen (A) and
when opened, a cheesy-like-pus were observed (B). No presence of tumor in the other organs
observed.

Figure 6: Lou’s follow up CBC result, a month after surgery. January 19, 2024.

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 After the removal of her spleen, her red blood cell (RBC) count profile was significantly
improved. But her septic uterus was also getting worse day after day which decreases her
prognosis. On February 9, 2024, with the slight improvement of her blood profile, the attending
veterinarian decided to proceed on removing her septic uterus to save her life. The decision was
risky but her septic uterus was getting advanced.

The surgical procedure (Ovariohysterectomy), removing of her septic uterus (pyometra)

was done successfully. Fortunately, her condition improved and was adopted on March 01, 2024.

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DISCUSSION

In Dumaguete City, Negros Island in the southern Philippines, growing population of

stray cats and dogs was a problem. As a solution to this problem, their city administers human
DEPO injection to female stray cats and dogs as contraceptive. But according to veterinarians in
Dumaguete Animal Sanctuary, 100% of their rescued female cats and dogs that received depo
injection were positive with pyometra, a septic uterus. Pyometra is a serious and potentially life-
threatening infection of the uterus that causes it to fill with bacteria and pus. Many dogs with a
pyometra have vaginal discharge, an open pyometra, and may feel very sick with a poor appetite,
lethargy, vomiting and sometimes increased thirst or urination. Any female dog that has not been
spayed can develop a pyometra, but they are more common in middle-aged to older female dogs
and cats who have been through multiple heat cycles. Most dogs have a good prognosis if
diagnosed and treated promptly, but it can be deadly if left untreated. The preferred treatment is
to surgically remove the uterus and ovaries by performing an ovariohysterectomy (spay). Dogs
diagnosed in the early stage of the disease are very good surgical candidates. The pyometra
surgery is somewhat more complicated than a routine spay at this stage. However, most dogs are
diagnosed when they are quite ill, resulting in a more complicated surgical procedure and a
longer period of hospitalization. Intravenous fluids are required to stabilize the dog before and
after surgery. Antibiotics are usually given for two weeks post-operatively (Weir and Ward,
2023).
The Ehrlichia and Anaplasma rickettsiae are present in many parts of the world, including
Phlippines. They are transmitted by ticks (including the brown dog tick, lone star tick, and black-
legged tick) that become infected after feeding on infected animals. People, cats, and other
domestic animals can occasionally become infected with these organisms, but dogs are the main
host. In dogs, E. canis causes the most potentially severe clinical presentation of
the Ehrlichia and Anaplasma spp. Signs arise from involvement of the hemic and
lymphoreticular systems; many dogs experience self-limiting infection, but some may develop a
secondary quiescent phase of disease followed by a severe and life-threatening third chronic
stage. Clinical findings in acute ehrlichiosis include reticuloendothelial hyperplasia, fever,
generalized lymphadenopathy, splenomegaly, thrombocytopenia. During the acute phase of E
canis infection in dogs, the hemogram is usually normal but may reflect a mild normocytic,
normochromic anemia; leukopenia; or mild leukocytosis. Thrombocytopenia is common, but
petechiae may not be evident, and platelet decreases may be mild in some animals (Foley, July
2020). The treatment for canine anaplasmosis is the same as that for other closely related tick-
borne infections, including ehrlichiosis and Lyme disease—the antibiotic doxycycline. Many
infected dogs are treated for two to four weeks (the longer course more often if co-infected with
Lyme disease). In most cases, symptoms improve rapidly. Dogs are often markedly better 24 to
48 hours after therapy is started, and the prognosis for clinical recovery is excellent (Weir and
Ward, 2023).
Splenic tumors are very common in dogs, especially as they grow older. Because the
spleen stores and produces red blood cells, even benign tumors may be at risk of rupture and
bleeding, causing acute illness. Hemangioma and hemangiosarcoma are two of the most common

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primary tumors found in spleens. Hemangiomas are benign, while hemangiosarcomas are
malignant. The prognosis for any specific spleen tumor depends on the type of tumor. Benign
tumors, which may still require treatment and removal, carry a better prognosis, or outcome,
overall than malignant tumors, especially if treated early (Jones, April 2022). In Lou’s state the
seen tumor was concluded as Hemangiosarcoma since it was focal and no other tumors seen in
other organs.

REFERENCES:

Anderson, J. (2024, February 7). Lou - Adopt a stray • Dumaguete Animal Sanctuary.
Dumaguete Animal Sanctuary. https://www.dumagueteanimalsanctuary.com/lou/
Pyometra in dogs | VCA Animal Hospitals. (n.d.). Vca. https://vcahospitals.com/know-your-
pet/pyometra-in-dogs
Anaplasmosis in dogs | VCA Animal Hospitals. (n.d.). Vca. https://vcahospitals.com/know-your-
pet/anaplasmosisindogs#:~:text=The%20treatment%20for%20canine%20anaplasmosis,
%2Dinfected%20with%20Lyme%20disease).
Foley, J. E. (2020, July 6). Ehrlichiosis, anaplasmosis, and related infections in animals. MSD
Veterinary Manual. https://www.msdvetmanual.com/generalized-conditions/rickettsial-
diseases/ehrlichiosis,-anaplasmosis,-and-related-infections-in-animals
Vmd, L. J. (2023, March 24). Spleen cancer in dogs. PetMD.
https://www.petmd.com/dog/conditions/cancer/spleen-cancer-dogs
Lawrence T. Goodnough, Barry Skikne, Carlo Brugnara; Erythropoietin, iron, and
erythropoiesis. Blood 2000; 96 (3): 823–833.
doi: https://doi.org/10.1182/blood.V96.3.823

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