Dog with severe esophagus damage after allergic shock from insect

Abstract

This report describes the development of oesophagitis and oesophageal stricture in a dog secondary to anaphylaxis. A 9-month-old male entire Brussels Griffon presented in anaphylactic shock after exposure to Hymenoptera species (Sp). The dog had a history of an anaphylactic reaction after exposure to Hymenoptera, successfully managed with antihistamines and dexamethasone. On this presentation, the dog was vomiting, lethargic, hypotensive and hyperlactatemic, with a mild elevation in serum alanine transaminase (ALT) concentration and gall bladder wall oedema. An adrenaline constant rate infusion was required for 48 h; however, persistent vomiting and regurgitation occurred despite prokinetic and antiemetic therapy. The dog developed hypersalivation and discomfort around the neck on day 6 of hospitalisation. Oesophagitis was suspected and confirmed by endoscopic examination. The dog remained in hospital for a total of 10 days with a percutaneous endoscopic gastrostomy tube (PEG) placed. He was discharged and managed as an outpatient for 1 month while deescalating therapy and could not eat orally during this time. Repeat endoscopy and an oesophagogram performed 5 weeks post-discharge revealed a 2 mm oesophageal stricture 9.8 mm in length proximal to the lower oesophageal sphincter. The dog required four endoscopic guided ballooning procedures before the oesophageal diameter was deemed acceptable. After the first procedure, the dog could eat orally and gastrointestinal signs resolved. His PEG tube was removed after the fifth endoscope, 93 days from initial presentation, and further ballooning was not required. Gastrointestinal signs are commonly seen with anaphylaxis; however, these are usually self-limiting. This was the first description in the veterinary literature of severe oesophagitis and stricture formation secondary to anaphylaxis.