1810. PUO - Pyrexia of Unknown Origin in a hiding Maltese

Today is Wednesday. On Sunday, the young couple from Bukit Panjang brought a 4-year-old male neutered Maltese to consult me. Late in the night, the dog suddenly went to a corner to hide. "He was restless and reluctant to walk," the young lady said. "He panted but could walk."

So the owner took him to an emergency clinic on that Saturday. Tramadol and meloxicam inj and SC drip were given.
Fever was present. She was told to monitor the breathing closely and keep JJ in a cool place and ensure access to water and to see her regular vet the next day. The owner was worried about tick fever as she had plucked out a fat mother tick 2 weeks ago from the dog. Also the dog is not on anti-tick spot on medication but never had tick problems.

The first blood test taken on Jul 21, 2012 at 8.54 pm showed high RBC, HCT and Hb and low MCHC.  Other results were normal.

On Sunday morning, I saw the dog at 10 am. The dog still had fever at 40C.  "The high RBC and Hb is a concern. I need another blood test to check," I asked for permission as the lady thought that the dog was dehydrated. Clients are much more sophisticated with the internet nowadays.

Other than fever, JJ had some pain on his back spinal area. He gave a soft "ha" when I pressed the spinal area between T7-13 and this effect could be reproduced as the owner could hear it too. "Did the vet check on this?" I asked. "Yes," she said. "She did it in a different way." No abdominal pain could be found but the dog was already given painkillers yesterday.

"There is some pain, now muffled by the use of Tramadol and meloxicalm painkiller injections given yesterday," I said. "Did the dog fall on his back?"

The dog could have tripped. For the pat 4 years, he hoped over the concrete bar to go inside the toilet for around 5x/day. Over 4 years, this would be over 6,000 hops and punishing to the spinal column. Pain --- panting --- leads to "fever".

2ND BLOOD TEST 
July 22, 2012  10 am
The second blood test showed normal RBC, HCT and Hb and MCHC. "RBC, HCT and Hb" are on the higher side of the normal range," I explained. "MCHC was on the lower side of the normal range. " Other results were normal.

"The bad news is that the liver enzymes are high  ALt 219( normal <59) and AST 196 (<81)," I said. "There could be hepatitis just starting and so the total WCC did not go up. However, the neutrophils are 77% as compared to 56% from the first vet. It is possible that there is a bacterial infection just starting. Since the first vet did not do this test, it would not be known if there was abnormal liver function."

So was this a case of heptititis causing fever? The owner consulted me on Tuesday as the dog was dragging his left hind feet but otherwise energetic and happy and eating. No fever but then he was on anti-fever medication. "The first vet used the hind legs to collect blood," I showed the lady the bruised black area around the hocks. Some vets like to collect blood from the back legs but usually no problem in walking."
Today, Wednesday, I phoned the owner at 5 pm. JJ was ok.

Advised toilet ramp and attention to paw licking. Wear booties? The owner didn't like the idea. I suggested a short-term use of anti-inflam and also trimming and washing the paws.

Conclusion. Cause of liver disorder and hepatitis? Hard to say. The dog was not vaccinated. He was walked daily outdoors by the mum and could have picked up an infection. He could have got infected in the liver from unhealthy dog treats. So, it is difficult to come to a conclusion. LD diet was given for 2 weeks for the liver and we have to wait and see.