Association between intestinal lymphangiectasia and expression of inducible nitric oxide synthase in dogs with lymphoplasmacytic enteritis

Intestinal lymphangiectasia in a dog: Clinical, ultrasonographic, endoscopic, and strain elastographic aspects

Background

Primary intestinal lymphangiectasia in dogs is a condition characterized by dilation of the lymphatic vessels in the intestine. It has serious consequences, such as protein loss. Early diagnosis and appropriate treatment are essential for the quality of life of affected animals.

Case Description

A 10-month-old female Border collie with persistent diarrhea for 3 months associated with weight loss, emesis, steatorrhea, and anorexia. During the investigation, the patient showed signs of dehydration; based on inspection and bone and muscle palpation, there was a reduction in the body condition score, as well as limb edema. An abdominal ultrasound revealed intestinal wall thickening and signs indicative of lymphangiectasia. The strain elastography revealed changes in intestinal rigidity parameters. After upper digestive endoscopy and histopathological examination, the female patient was diagnosed with intestinal lymphangiectasia. The female patient was treated with a low-fat diet and immunosuppressive drugs, which resulted in clinical and laboratory improvement and a reduction in the hardness rate on elastography.

Conclusion

This case highlights the clinical, ultrasonographic, endoscopic, and strain elastographic findings of intestinal lymphangiectasia in a dog, demonstrating elastography's potential as a diagnostic and monitoring tool while confirming the disease's responsiveness to immunosuppressive therapy and dietary management.

Pathophysiology, Diagnosis, and Management of Canine Intestinal Lymphangiectasia: A Comparative Review

Intestinal lymphangiectasia was first described in the dog over 50 years ago. Despite this, canine IL remains poorly understood and challenging to manage. Intestinal lymphangiectasia is characterized by variable intestinal lymphatic dilation, lymphatic obstruction, and/or lymphangitis, and is a common cause of protein-losing enteropathy in the dog. Breed predispositions are suggestive of a genetic cause, but IL can also occur as a secondary process. Similarly, both primary and secondary IL have been described in humans. Intestinal lymphangiectasia is definitively diagnosed via intestinal histopathology, but other diagnostic results can be suggestive of IL. Advanced imaging techniques are frequently utilized to aid in the diagnosis of IL in humans but have not been thoroughly investigated in the dog. Management strategies differ between humans and dogs. Dietary modification is the mainstay of therapy in humans with additional pharmacological therapies occasionally employed, and immunosuppressives are rarely used due to the lack of a recognized immune pathogenesis. In contrast, corticosteroid and immunosuppressive therapies are more commonly utilized in canine IL. This review aims toward a better understanding of canine IL with an emphasis on recent discoveries, comparative aspects, and necessary future investigations.