Focal intestinal lipogranulomatous lymphangitis in a male Havanese

A four-year-old male Havanese was presented with chronic intermittent clinical signs of gastrointestinal disease, mainly vomiting (current episode lasting for approx. two to three weeks) and hyporexia (currently present for two days). Bloodwork showed marked panhypoproteinemia, hypocholesterolemia, mild hypokalemia and hyponatremia, mild non-regenerative normocytic normochromic anemia, and leukocytosis characterized by neutrophilia. Abdominal ultrasound revealed gas-filled loops of small intestine with increased wall thickness, reactive and focally consolidated appearing mesentery with poor delineation from surrounding tissues, and a mild amount of free peritoneal fluid. Further diagnostics included a diagnostic laparotomy with biopsy sampling of multifocal small whitish nodules located on the serosal aspect of the small intestine and the mesentery. Supportive treatment was initially unsuccessful, and the dog was referred for further diagnostic evaluation. Histopathologic findings were inconclusive as for the underlying etiology at this time. The surgical findings together with the histopathologic, clinical, clinicopathologic, and diagnostic imaging results were suspicious for a chronic protein-losing enteropathy (PLE) with the rare manifestation of lipogranulomatous lymphangitis, which was supported by the histologic finding of intestinal lymphangiectasia and granulomatous lymphangitis. Further diagnostic evaluation excluded other causes of hypalbuminemia ( hepatic insufficiency, protein-losing nephropathy) and confirmed the diagnosis of regional intestinal lipogranulomatous lymphangitis (ILL). Initiation of treatment comprised of a hypoallergenic diet, parenteral cobalamin supplementation, immunosuppressive medication, and empiric deworming, the dog's clinical signs and clinicopathologic abnormalities improved within a few days. Follow-up evaluations on days three, seven, 14, and one month after the initial referral showed further improvement and stabilization of the serum total protein and albumin concentration. The dog remained clinically stable and had normal clinicopathologic findings on a commercial low-fat diet until the last follow-up at about five years (58 months) after being diagnosed with ILL. This case report emphasizes that intestinal lipogranulomatous lymphangitis should be considered an important differential diagnosis in dogs with focal or multifocal, circumferential or miliary serosal intestinal proliferations and a history of chronic gastrointestinal clinical signs.