A 7-year-old male castrated mixed breed dog was presented to the Cornell University Hospital for Animals (CUHA) Emergency Service for a two day history of progressive lethargy, hind limb pain and lameness. Physical examination revealed tachycardia, hyperthermia, and severely painful pelvic limbs. Blood was drawn for a 4DX Snap test, which was positive for Lyme disease. The clients elected conservative treatment and a 30-day course of doxycycline was initiated.

Seven days after initial presentation, the patient presented to the Small Animal Community Practice Service for a recheck examination. The patient’s lameness had resolved since starting doxycycline; however, he had been inappetent and was vomiting throughout the preceding week. Physical examination at the recheck examination was unremarkable. Blood was submitted for a chemistry panel and free-catch urine was submitted for a urinalysis (a CBC was declined). The chemistry panel revealed markedly elevated liver enzymes and the urinalysis revealed proteinuria. Serum for a leptospirosis microscopic agglutination test (MAT) was submitted. Urine collected via cystocentesis was submitted for culture. The patient was taken off of doxycycline due to potential hepatopathy and placed on amoxicillin and S-adenosylmethionine (Denosyl).

The leptospirosis test confirmed a diagnosis of leptospirosis and there was no growth on the urine culture. The patient was doing well at home at this time and was switched back to doxycycline. The patient’s chemistry panel was rechecked four weeks later and all liver values had returned to normal range. The patient was lost to follow-up after recommendations were made to continue monitoring urinalysis and blood work. This seminar will discuss the physical examination findings, differential diagnosis and outpatient treatment for leptospirosis.