Unusual blood protein pattern in dog with Angiostrongylus vasorum

Abstract

A 7-year-old female intact pug was presented for a six-month history of cough, dyspnea, and exercise intolerance. Treatment with fenbendazole was initiated 3 days before referral based on a positive blood quantitative PCR for Angiostrongylus vasorum (A. vasorum) without improvement of the clinical signs. The dog lived in Belgium with a traveling history to Corsica and Canada. On physical examination, the dog was tachypneic with expiratory dyspnea. Mild non-regenerative anemia, monocytosis, eosinophilia, and basophilia were identified on hematology. Biochemistry revealed hyperproteinemia due to hyperglobulinemia. The protein capillary zone electrophoresis (CZE) identified a restricted polyclonal (or oligoclonal) peak in the beta-globulin region and a tall and narrow peak in the gamma-globulin region, suggestive of either restricted polyclonal or monoclonal gammopathy. Further diagnostic investigations included thoracic radiographs, echocardiography, abdominal ultrasound, urinalysis, snap test 4Dx, Leishmania spp. serology, and Leishmania spp. PCR on bone marrow aspirates. Severe proteinuria was noted with a urine protein to creatinine ratio (UPCR) of 7.54. No infectious agents other than A. vasorum were identified. Treatment with fenbendazole was pursued for 7 days, followed by a spot-on application of imidacloprid/moxidectin combined with tapering the anti-inflammatory dose of steroids, with complete resolution of the respiratory signs. At 1-month recheck, hyperglobulinemia and proteinuria completely resolved, and the thoracic radiographic images improved. To the authors' knowledge, this case is the first to describe such a gammopathy associated with chronic angiostrongylosis.