{"id":31086,"date":"2022-06-17T15:37:23","date_gmt":"2022-06-17T15:37:23","guid":{"rendered":"https:\/\/todaysveterinarypractice.com\/?p=31086"},"modified":"2022-06-20T18:39:58","modified_gmt":"2022-06-20T18:39:58","slug":"disseminated-nocardiosis-in-a-dog","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/emergency-medicine-critical-care\/disseminated-nocardiosis-in-a-dog\/","title":{"rendered":"Disseminated Nocardiosis in a Dog"},"content":{"rendered":"

Nocardia<\/i> bacteria are facultative intracellular pathogens that uncommonly cause disease in dogs. Clinical manifestations include cutaneous\u2013subcutaneous, pulmonary, and disseminated nocardiosis. This case report describes a case of disseminated nocardiosis with dermatologic, respiratory, and neurologic signs in a dog. <\/span><\/p>\n

Signalment and History<\/h2>\n

A 6-month-old, 24-kg, female intact Rottweiler presented to the University of Pennsylvania Emergency Service as a referral for a 2-week history of respiratory distress, tracheobronchial lymphadenopathy, fever, and diarrhea that were not responsive to medical management, including multiple antibiotics (doxycycline, ampicillin and sulbactam, and metronidazole), fluconazole, and steroids. Diagnostics prior to presentation included multiple sets of thoracic radiographs showing progressive tracheobronchial lymphadenopathy; fungal testing for blastomycosis, histoplasmosis, and cryptococcus, with negative results; and an abdominal ultrasound that was unremarkable. The dog was hospitalized multiple times, but her signs continued to progress. A generalized seizure prompted referral. <\/span><\/p>\n

About a month prior to the onset of respiratory signs, the patient developed ulcerative skin lesions on her vaginal mucosa and ventral abdomen that resolved with prednisone (dose unknown). The owners reported that 2\u00a0littermates of the patient died at 4 months of age after developing similar dermatologic, respiratory, and neurologic signs; both were reportedly negative for rabies and canine distemper virus (CDV).<\/span><\/p>\n

Presentation and Diagnosis<\/h2>\n

On presentation, the patient was tachypneic with increased expiratory effort and a frequent cough. Harsh lung sounds were auscultated bilaterally. Her rectal temperature was 103.3 \u00b0F. The remainder of the physical examination was unremarkable. <\/span><\/p>\n

Arterial blood gas testing<\/a> performed on room air showed hypoxemia (PaO2<\/sub> = 63 mm Hg; reference range, 80 to 105 mm Hg) and a mild hyperlactatemia (2.5\u00a0mmol\/L; normal, <2 mmol\/L).1,2<\/sup> Thoracic radiography revealed marked middle tracheobronchial lymphadenopathy and a mixed pulmonary pattern (<\/span>FIGURE 1<\/b><\/span>).\u00a0<\/span><\/p>\n

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Figure 1. Thoracic radiographs obtained at admission. Marked middle tracheobronchial lymphadenopathy and a mixed pulmonary pattern are present. (A) Right lateral view.<\/p><\/div>\n

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Figure 1. Thoracic radiographs obtained at admission. Marked middle tracheobronchial lymphadenopathy and a mixed pulmonary pattern are present. (A) Right lateral view. (B) Left lateral view.<\/p><\/div>\n

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Figure 1. Thoracic radiographs obtained at admission. Marked middle tracheobronchial lymphadenopathy and a mixed pulmonary pattern are present. (C) Ventral-dorsal view.<\/p><\/div>\n

The patient was admitted and treated as described in <\/span>BOX 1<\/b><\/span>. Clindamycin and ceftazidime were selected to provide broad-spectrum coverage without using classes of antimicrobials that the patient had previously received.<\/span><\/p>\n

Box 1 Initial Treatment at Presentation<\/div>
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