Acute hypersensitivity Reaction with Anaphylaxis of Unknown Cause.

PATIENT INFORMATION:

Age: ~2 year old

Gender: Male neutered

Species: Canine

Breed: Chihuahua Mix

Weight: 15lbs

HISTORY:

Previously healthy and fully vaccinated. Presented acutely at home foaming at the mouth with grey mucous membranes and weakness. No cutaneous signs noted. No history of toxin ingestion, envenomation, medications, trauma or illness.

INITIAL ULTRASOUND ANALYSIS:

Mild-moderate free fluid in the abdomen. Severely thickened isoechoic gallbladder wall.

ADDITIONAL DIAGNOSTICS:

SERIAL ULTRASOUNDS IMAGES:

Gallbladder

Pancreas

SELECT CLIPS:

**Image 1: Marked pancreatic change 2-3 hours after initial presentation. Note “tiger stripe” appearance secondary to edema.**

**Image 2: Abdominal free fluid at presentation.**

DIAGNOSIS:

Anaphylaxis of unknown origin

CASE OUTCOME:

Patient was treated with steroids, diphenhydramine, metronidazole and fluid therapy. After 36 hours the patient returned to normal.

PROGNOSIS/DISCUSSION:

It has been found that elevated ALT and gallbladder wall changes are significantly associated with anaphylaxis in dogs with acute hypersensitivity reactions. Gallbladder changes alone are not pathognomonic for anaphylaxis. Other potential causes of gallbladder changes include right-sided congestive heart failure and should be ruled out.

Spontaneous abdominal effusions are commonly associated with anaphylaxis.

References:

*Quantz JE, Miles MS, Reed AL, White GA. Elevation of alanine transaminase and gallbladder wall abnormalities as biomarkers of anaphylaxis in canine hypersensitivity patients. J Vet Emerg Crit Care (San Antonio). 2009 Dec;19(6):536-44. doi: 10.1111/j.1476-4431.2009.00474.x. PMID: 20017759.

Hnatusko AL, Gicking JC, Lisciandro GR. Anaphylaxis-related hemoperitoneum in 11 dogs. J Vet Emerg Crit Care (San Antonio). 2021 Jan;31(1):80-85. doi: 10.1111/vec.13017. Epub 2020 Oct 29. PMID: 33118683.

Summers AM, Culler C, Cooper E. Spontaneous abdominal effusion in dogs with presumed anaphylaxis. J Vet Emerg Crit Care (San Antonio). 2021 Jul;31(4):483-489. doi: 10.1111/vec.13070. Epub 2021 Apr 29. PMID: 33913584.