51³Ô¹ÏÍø

Nadine Jones, Staff Clinician in Emergency and Critical Care, and Tom Greensmith, Senior Lecturer in Emergency and Critical Care

Charlie, a four-year-old retired racing greyhound, was referred for management of suspected cutaneous and renal glomerular vasculopathy (CRGV) last autumn.

On presentation, Charlie had severe generalised peripheral oedema; his skin was erythematous on his entire ventrum, extending cranially to his neck as well as involving all four limbs. An ulcerative skin lesion was present on his dorsal right antebrachium. He was markedly polyuric and markedly thrombocytopenic.

Charlie was hospitalised at the Queen Mother Hospital for Animals (QMHA) for almost two weeks before returning home and making a good recovery thanks to the collaboration between the RVC team and his referring vet practice.

As there are no confirmatory tests for CRGV, diagnosis was made on the basis of compatible clinical signs and excluding other causes of acute kidney injury and thrombocytopenia. While skin biopsies can be helpful in the diagnosis, they do not always confirm the disease, even in animals who have it.

Plasma exchange and wound management

Charlie underwent two cycles of membrane-bound therapeutic plasma exchange, on the first and third day of his admission. He was also started on pentoxifylline and clopidogrel in an effort to treat the vasculopathy associated with CRGV.

While the exact cause of CRGV remains unknown, plasma exchange is one of several treatment modalities for some forms of thrombotic microangiopathy in human patients. One possible mechanism, ADAMTS13 dysregulation, is currently being researched by clinicians at the QMHA. The team is also collaborating in a multicentre study to assess if plasma exchange is associated with improved survival in affected dogs.

Following his second cycle of therapeutic plasma exchange, Charlie's platelet count normalised and his other signs also began to improve, with his severe cutaneous erythema resolving within five days of admission to the RVC.

Charlie's wound progressed during his hospitalisation to span approximately 75% of his right antebrachium. The team discussed with Charlie's owners his ongoing options: continuing with management of his extensive wound or limb amputation. Given that Charlie could ambulate and, out of a desire to salvage the limb, it was decided to proceed with wound management.

Initially Charlie underwent general anaesthesia several times for wet to dry bandage application but due to improvements in the appearance of the wound, a vacuum dressing was applied while under general anaesthetic six days after admission.

Subsequent dressing changes under sedation were performed and the wound continued to heal well. By discharge, there was a healthy granulation bed and the edges of the wound were starting to epithelialise.

After discharge

The referring vet practice continued the wound management following discharge, changing Charlie’s bandage regularly. As Charlie's wound cultures revealed multidrug resistant bacteria, the team was advised to barrier nurse him and keep him away from their other patients.

Clinical Connections got in touch with owner Anette Gallacher recently to find out how Charlie has been getting on since discharge. Anette, who adopted Charlie after he retired from racing, said: “Last November something terrible happened – Charlie got very sick. We were extremely worried but the RVC team was very kind and that gave us hope, despite the severity of Charlie’s condition. He had plasma exchange therapy twice over three days and the staff worked incredibly hard to manage Charlie’s wounds.

“By mid-January this year, Charlie was back to being his energetic, boisterous and enthusiastic self and his appetite had fully returned. The wound on his leg took several months to fully heal and our local vets were also invaluable at managing that. Our local practice, which managed Charlie’s leg wound for many months, with so much kindness and care, is Oaks Veterinary Centre in Birmingham.”