The Mystery of Sneezing Sonny

by Jessica Parker BVSc MVPH MRCVS ,Rotating Veterinary Intern

Sonny, a happy and healthy 5 year old Golden Retriever, presented to our MiNightVet out of hours team on a Tuesday night after he suddenly began sneezing and developed a nose bleed during a walk earlier that evening. The emergency team worked quickly to assess Sonny and to stabilise the bleeding which was coming from his right nostril. Clinical examination revealed nothing major other than slightly reduced airflow from the bleeding nostril. However, as the bleeding would not stop, Sonny was admitted to the hospital overnight to receive medication and close monitoring from the nursing team. Whilst the bleeding significantly reduced following medical treatment, any excitement started his nosebleeds again.

Initial bloods performed that night showed that his blood was able to clot within a normal time but he had a higher than normal number of white blood cells present, specifically a type of cells known as eosinophils which are important in the immune system defence, especially in parasite infections. Previous blood results from Sonny’s own vet a few months earlier when his appetite was reduced also showed an increase in this type of cells, although milder. Sonny had received a course of an anti-parasite treatment called fenbendazole which improved his appetite and he went back to his usual self. Although Sonny did not show any other expected symptoms, the emergency team were suspicious of a parasitic infection causing his nosebleeds and he was tested for this, however the mystery continued, as the results were inconclusive. The veterinary laboratory service offered to test his samples directly but the results would take a few days.

The MiNightVet team discussed the case with ChesterGates referral clinician Menai Hayes and Sonny was quickly referred to the Internal Medicine team on Wednesday morning. Further in-house diagnostic tests also found blood in his urine and some internal bleeding. Whilst waiting for the laboratory results, other possible causes for his symptoms had to be investigated. Sonny had a general anaesthetic and CT scan that afternoon which showed changes in the blood vessels of his lungs, such as small circular swellings (red arrows), alongside a swelling within his right nostril. There were no signs of masses or foreign bodies but these findings were very suspicious for a certain parasite infection. He also had a surprise in store for the team when a foreign body, suspected to be a bone, was found to be hiding in his stomach.

An anti-parasitic treatment containing imidacloprid and moxidectin was applied to his skin that evening. Sonny remained hospitalised overnight to continue medication which helped his blood to clot and to receive nursing care; his blood loss was monitored closely in case he needed a transfusion. The bleeding significantly improved by Thursday morning and had stopped completely by the evening. On Friday morning, the results from the laboratory came through, and the team were indeed correct – poor Sonny had been infected by the parasite Angiostrongylus vasorum, more commonly known as Lungworm.

Sonny was discharged back to his family that day, with instructions to keep a close eye on him to make sure there was no deterioration after starting treatment, such as further bleeding and respiratory signs from the departing parasite burden. He continued to have his medication to control any bleeding for the next few days at home.

The quick action taken by his owner, and the multi-disciplinary approach between the MiNightVet and ChesterGates teams, meant that the time from onset of symptoms to diagnosis and treatment significantly improved Sonny’s prognosis and recovery period. We are happy to report that Sonny has made a full recovery as you can see from his handsome picture below and is receiving his anti-parasite treatment on a monthly basis, alongside the rest of his four-legged family.