* A CASE STUDY - PICI
We recently treated an 11-year-old Hungarian Puli (yes, the dog breed which looks like a mop). He came on a Monday a few weeks ago with a number of problems: a number of his lymph nodes were enlarged; he was coughing; and he had a very high temperature. He was extremely unwell.

Chest x-rays showed a likely pneumonia. A blood test performed at the time was unremarkable apart from a very high white blood cell count. This usually means that somewhere in the body there is a source of inflammation and/or infection. He also had blood in his urine. A sample from his lungs and his urine were sent to an external laboratory for culture and sensitivity. We also took cells from his enlarged lymph nodes.

Whilst waiting for his results he was treated with antibiotics, anti-inflammatories and fluids. Over a 2-3 day period he gradually deteriorated. His high temperature did not improve and he was eating and doing very little. By Thursday we had his results. They showed there to be no infection in his lungs, urinary tract or lymph nodes. He also had no evidence for cancer. After discussion with his owners it was decided not to take investigation further and we took a risk and suppressed his immune system with corticosteroids in the hope that the disease was immune mediated.

By Friday he had perked up and by Saturday he was bright and eating well. We sent him home on Saturday afternoon!

The following Monday morning we saw him for reassessment. At this point he looked fantastic and had been well at home over the weekend. However, on examination his heart rate was 280 (about twice what is should have been). An ECG and echocardiograph confirmed heart disease. He had been diagnosed with a heart murmur prior to this recent illness but not with heart disease that required treatment. The course of this recent illness damaged the heart further and one of the chambers of the heart was so large it was causing an arrhythmia (a disturbance in the rhythm of the heart). He has since been started on medication for this.

Currently he is at home and well. He is bright and eating well and can almost walk as far as he normally does. We do not know the exact cause of his illness, but are hopeful that he will continue to do well with immunosupression. We will see him again for assessment next week, and will keep you updated.