Case 9

The owners are happy that Tupper seems better and they decline further work-up. They opt to take him home despite the fact that you don't have a diagnosis. You send home the low-residue diet plus fenbendazole for prophylactic deworming (50 mg/kg orally for three days) and instruct the owners to bring Tupper back if he develops further vomiting or the diarrhea persists.

The owners call about 10 days later and tell you that Tupper was better for the first week after he was home, but now he has had two episodes of vomiting and is having explosive, watery, dark-colored diarrhea. They also mention that their Bengal kitty, Charlie, has had diarrhea for the last 24 hours and is not eating. You ask them to bring both pets in for evaluation.

On presentation Tupper is febrile (104.2 F; 40.1 C), lethargic, tense on abdominal palpation, and dehydrated. You opt to recheck his abdominal radiographs at this time to be sure there is no evidence of obstruction or intestinal perforation; the findings are negative.

You also recheck his CBC and find that he has a neutropenia with a degenerative left shift and toxic neutrophils. You ask your technicians to get Tupper started on intravenous fluids and broad-spectrum antibiotics (enrofloxacin 5 mg/kg intravenously b.i.d.; ampicillin 10 mg/kg intravenously t.i.d.) while you assess Charlie.

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