Intestinal lymphangiectasia secondary to inflammatory bowel disease in dogs: a case report

Abstract

Intestinal lymphangiectasia is characterized by the dilation of the lymphatic vessels of the intestinal mucosa and submucosa, which results in the extravasation of plasma, proteins, lymphocytes, and chylomicrons into the intestinal lumen. This process compromises the absorption of nutrients, especially fats and proteins, leading to malabsorption. Clinically, affected animals may exhibit diarrhea, vomiting, hypoproteinemia, hypoalbuminemia, and, as a consequence, cavitary effusions, especially ascites. This report describes the case of a male, non-neutered, mixed breed dog, of approximately five years old, seen at the Veterinary Clinical Center in Passo Fundo-RS, with a history of sporadic vomiting, diarrhea, progressive weight loss, and ascites. Physical examination revealed mild signs of dehydration, pain abdominal palpation, and abdominal effusion. Laboratory tests indicated leukocytosis, hypoproteinemia, and hypoalbuminemia. Abdominal ultrasonography showed thickening of intestinal loops, chronic pancreatopathy, and gastritis, leading to the hypothesis of inflammatory bowel disease (IBD) and intestinal lymphangiectasia. After clinical stabilization with supportive therapy and low-fat gastrointestinal diet, the patient showed temporary improvement. However, the patient returned with worsening of the clinical picture and ascites. New laboratory tests have reinforced the suspicion of protein-losing enteropathy (PLE). Upper gastrointestinal endoscopy was performed with collection of intestinal biopsies, whose histopathological examination confirmed the diagnosis of multifocal lymphoplasmacytic enteritis, multifocal lymphoplasmacytic gastritis, and mild lymphangiectasia. Treatment with prednisolone at an immunosuppressive dose and maintenance of the specific diet resulted in significant clinical improvement. The case highlights the importance of differential diagnosis between IBD and intestinal lymphangiectasia, as well as intestinal biopsyto confirm enteropathies. Nutritional management associated with immunosuppressive therapy has been shown to be effective in controlling the clinical picture.