Atypical pyometra in a canine with hyperadrenocorticism and endocardiosis: a clinical case

Abstract

The aim of this report was to document the presentation of a 12-week-old pyometra in an 11-year-old female Chihuahua with hyperadrenocorticism and endocardiosis. The patient presented with clinical and paraclinical signs consistent with chronic hyperadrenocorticism. An adrenocorticotropic hormone (ACTH) stimulation test confirmed the hyperadrenocorticism (post-stimulation cortisol of 27.79 µg/dl). However, the progression of subclinical pyometra was evident at 12 weeks of evolution (Acute Patient Physiologic and Laboratory Evaluation – fast [APPLE-fast] of 15; Quick Sequential Organ Failure Assessment [qSOFA] of 1) with additional signs of pulmonary edema secondary to endocardiosis. At 48 hours post-surgery, the patient exhibited lethargy, anorexia, an APPLE-fast of 26, and clinical criteria of SIRS-3. After the therapeutic failure of the previous approach with enrofloxacin plus ampicillin/sulbactam, and later cefovecin, it was decided to administer gentamicin for 3 days, with a favorable clinical and paraclinical response, and an APPLE-fast of 19. The result of the urine culture revealed the presence of enterohemorrhagic Escherichia coli (EHEC) with a multidrug-resistant profile suggestive of extended spectrum beta-lactamase (ESBL). At the clinical follow-up 4 weeks after starting trilostane post-discharge, the tutor reported improvement in clinical signs of chronic polydipsia, polyuria, and polyphagia, with an appropriate quality of life score for monitoring hyperadrenocorticism. It is presumed that the classic clinical expression of pyometra and infectious cystitis was mitigated by the uncontrolled underlying hyperadrenocorticism, and the clinical course of the disease progressed to sepsis due to EHEC with apparent production of ESBL.