A 1 year old female spayed mixed breed dog presented to the Internal Medicine Service on July 2, 2015 for evaluation of a chronic cough. She began exhibiting a dry, hacking and often productive cough in March 2015. She brought up small flecks of food or phlegm; she coughed after eating or drinking and periodically throughout the day. She had no other clinical signs. In April, a primary veterinarian prescribed cefpodoxime and a course of low-dose prednisone. A complete blood count, fecal evaluation, and heartworm test were normal. In June, she was prescribed fenbendazole and doxycycline. Thoracic radiographs were taken, revealing lung pathology, and a tracheal wash was culture negative but contained abundant eosinophils on cytology. The patient was prescribed enrofloxacin and subcutaneous ivermectin. Her cough did not respond to therapy. On June 25th, a barium study found a questionable region of barium retention in the distal esophagus. On physical exam, the patient was anxious, her temperature was mildly elevated (102.6 degrees F), and her respiratory rate was elevated (60 bpm). Her respiratory effort was normal. She had harsh, increased lung sounds on auscultation with possible wheezes in her dorsal lung fields. Her physical exam was otherwise unremarkable. A complete blood count revealed leukocytosis, interpreted as a stress leukogram with eosinophilia and basophilia. A chemistry panel was within normal limits and fecal floatation was negative. Three-view thoracic radiographs found marked multifocal bronchiectasis with alveolar consolidation. CT confirmed the presence of bronchiectasis and found focally and diffusely affected lung lobes. Bronchiectasis extended to tertiary bronchi and the alveolar infiltrate was centered over the bronchiovascular bundles. Bronchioalveolar lavage revealed an abundance of eosinophils (>50%) on cytology. In summary, the problem list included the following items:

1. Chronic cough- dry, hacking and productive
2. Increased/harsh lung sounds with wheezes in dorsal lung fields
3. Peripheral eosinophilia
4. Severe multifocal bronchiectasis with alveolar consolidation
5. Sterile eosinophilic bronchoalveolar cytology

Main differentials included eosinophilic bronchopneumopathy or parasitic infection (Paragonimus kellicotti), and she was presumptively diagnosed with eosinophilic bronchopneumopathy with severe bronchiectasis. She was treated with a tapering dose of prednisone and her prognosis was guarded with lifelong medical management. She presented on July 6th and her cough was reported to be markedly improved. The owners did not pursue further investigation of a possible esophageal disorder. A course of high dose fenbendazole was added, since parasitic infection was not definitively ruled out.