Case 22 — New Murmur

Chimere, a 13-year-old female spayed Australian Shepherd cross.
Chimere — 13-year-old FS Australian Shepherd cross, 20 kg.

Primary clinician: Janet Aldrich, DVM & Aaron Wey, DVM, DACVIM (Cardiology)
Supervising clinician: Mark D. Kittleson, DVM, PhD, DACVIM (Cardiology)

Signalment

  • Species: Canine
  • Breed: Australian Shepherd cross
  • Age: 13 years
  • Sex: Female spayed
  • Weight: 20 kg
  • Name: Chimere

First Visit

Presenting Complaints

  • Non-weight bearing lameness & vomiting

Pertinent History

  • Non-weight bearing lame on right front leg since Saturday. Began vomiting Sunday evening; febrile (T = 104.0°F). Owner administered famotidine and Baytril 75 mg. Vomiting has since stopped.
  • Shifting leg lameness of long standing. Slowed down over the last year; weak in hind quarters; stumbles when running. Facial twitching and tooth chattering in last 2 weeks.
  • Neurology consult revealed underlying neuropathy. On Rimadyl and glucosamine/chondroitin for chronic arthritis.

Physical Examination

  • Obtunded and lethargic. T = 104.2°F; P = 120; R = 30.
  • CRT = 1.5 sec. Nuclear sclerosis OU. Fractured canines; severe calculus; moderate gingivitis. Serous nasal discharge.
  • Non-weight bearing lame on right front. Right lateral metacarpus swollen and painful. Right elbow painful but no effusion. Hip musculature atrophied bilaterally.
  • Adequate pulses with occasional dysrhythmia. No murmurs auscultated.
  • Exaggerated respiratory pattern; diminished breath sounds right dorsally.

Problems

  • Fever/Sepsis
  • Vomiting
  • Liver disease
  • Right forelimb lameness

Visit Summary

Problem 1 (Fever/Sepsis): WBC 21,100 with neutrophilia and left shift. Fibrinogen 600. Urine: 4+ protein, gram-positive cocci. Blood gas: metabolic acidosis with compensatory respiratory alkalosis. Blood and urine culture: pure Staph. intermedius. Started on Timentin 50 mg/kg IV QID.

Problem 3 (Liver disease): ALT 537, Alk Phos 621, cholesterol 597. Possibly due to long-standing carprofen therapy.

Problem 4 (Lameness): Radiographs: soft tissue swelling of lateral metacarpus with irregular bony changes at 4th metacarpal. Elbow radiographs normal. Consistent with possible septic process.

Clinical Diagnoses: Sepsis; right forelimb lameness.

Second Visit (Next Day)

Improving — sternal, drinking on own, no longer obtunded. T = 103.2°F. Culture sensitivities confirm Timentin sensitivity. Antibiotic therapy continued.

Third Visit (Third Day)

Looking brighter. Fever down to 102.6°F. Force-fed without vomiting. Will bear some weight on right forelimb.

New finding: A 3/6 systolic heart murmur auscultated over the mitral valve. Most likely due to vegetative endocarditis as a sequel to sepsis. Echocardiographic evaluation recommended.

Problems: Staph septicemia; right forelimb lameness; 2–3/6 systolic heart murmur.

Discharge: Continue Timentin IV at home (owner is a veterinary technician). Monitor temperature q4h. Rotate every 4 hours.

↑