title: Interstitial pneumonia and pulmonary hypertension associated with suspected ehrlichiosis in a dog.
abstract: BACKGROUND
  In dogs with canine monocytic ehrlichiosis (CME), respiratory signs are uncommon and clinical and radiographic signs of interstitial pneumonia are poorly described. However, in human monocytic ehrlichiosis, respiratory signs are common and signs of interstitial pneumonia are well known. Pulmonary hypertension (PH) is classified based on the underlying disease and its treatment is aimed at reducing the clinical signs and, if possible, addressing the primary disease process. PH is often irreversible, but can be reversible if it is secondary to a treatable underlying etiology. CME is currently not generally recognized as one of the possible diseases leading to interstitial pneumonia and secondary PH in dogs. Only one case of PH associated with CME has been reported worldwide.
  
  
  METHODS
  A seven-year-old, male intact, mixed breed dog was presented with 2 weeks history of lethargy and dyspnea. The dog previously lived in the Cape Verdean islands. Physical examination showed signs of right-sided congestive heart failure and poor peripheral perfusion. Thoracic radiography showed moderate right-sided cardiomegaly with dilation of the main pulmonary artery and a mild diffuse interstitial lung pattern with peribronchial cuffing. Echocardiography showed severe pulmonary hypertension with an estimated pressure gradient of 136 mm Hg. On arterial blood gas analysis, severe hypoxemia was found and complete blood count revealed moderate regenerative anemia and severe thrombocytopenia. A severe gamma hyperglobulinemia was also documented. Serology for Ehrlichia canis was highly positive. Treatment with oxygen supplementation, a typed packed red blood cell transfusion and medical therapy with doxycycline, pimobendan and sildenafil was initiated and the dog improved clinically. Approximately 2 weeks later, there was complete resolution of all clinical signs and marked improvement of the PH.
  
  
  CONCLUSIONS
  This report illustrates that CME might be associated with significant pulmonary disease and should be considered as a possible differential diagnosis in dogs presenting with dyspnea and secondary pulmonary hypertension, especially in dogs that have been in endemic areas. This is important because CME is a treatable disease and its secondary lung and cardiac manifestations may be completely reversible.
authors.affiliation: Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3508 TD, Utrecht, The Netherlands. M.L.denToom@uu.nl.
authors.forename: Marjolein Lisette den
authors.identifier: http://orcid.org/0000-0003-3558-0159
authors.initials: ML
authors.lastname: Toom
authors.affiliation: Department of Diagnostic Imaging, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3508 TD, Utrecht, The Netherlands.
authors.forename: Tetyda Paulina
authors.initials: TP
authors.lastname: Dobak
authors.affiliation: Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, PO Box 80.165, 3508 TD, Utrecht, The Netherlands.
authors.forename: Els Marion
authors.initials: EM
authors.lastname: Broens
authors.affiliation: Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3508 TD, Utrecht, The Netherlands.
authors.forename: Chiara
authors.initials: C
authors.lastname: Valtolina
mesh_terms: D000818:Animals; D000977:Antiparasitic Agents / Q000627:therapeutic use; D004283:Dog Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology*; D004285:Dogs; D004318:Doxycycline / Q000627:therapeutic use; D016873:Ehrlichiosis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000662:veterinary*; D006333:Heart Failure / Q000209:etiology / Q000662:veterinary; D006976:Hypertension, Pulmonary / Q000209:etiology* / Q000662:veterinary*; D017563:Lung Diseases, Interstitial / Q000209:etiology / Q000662:veterinary*; D008297:Male; D011724:Pyridazines / Q000627:therapeutic use; D013902:Radiography, Thoracic / Q000662:veterinary; D000068677:Sildenafil Citrate / Q000627:therapeutic use; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D000977:Antiparasitic Agents; D011724:Pyridazines; D014665:Vasodilator Agents; C041648:pimobendan; D000068677:Sildenafil Citrate; D004318:Doxycycline
keywords: Canine; Ehrlichiosis; Interstitial lung disease; Pulmonary hypertension; Reversible