A 7-year-old, female neutered Greyhound was referred with a history of chronic lethargy, anorexia and vomiting.
The dog was rescued with no history of travelling abroad.
Physical examination revealed depressed mental status, body condition score 5/9, temperature 39.3°C and pain on abdominal palpation.
Haematology showed mild mature neutrophilia (12806 μL) and lymphopenia (192 μL).
The blood smear was unremarkable.
The only biochemical abnormality was mildly increased ALP. cPLI was increased (462 μg/l).
Coagulation profile and electrolytes were within normal limits. Urine and sediment analysis were normal and urine culture was negative.
Abdominal ultrasound and thoracic radiographs were unremarkable.
The patient was hospitalized with i/v Hartmann’s solution fluid therapy, buprenorphine, maropitant, omeprazole, amoxicillin-clavulanate and starvation for 24 hours.
Clinical examination on the second day of hospital care showed a complete remission of clinical signs.
On the third day her condition deteriorated, showing anorexia, mental depression, pyrexia and pain on manipulation of the neck.
Haematology was repeated and revealed a mature neutrophilia (28000/μL).
Cerebrospinal fluid (CSF) and synovial fluid (bilateral carpi, elbows and stifles) were collected. Joint fluid cytology revealed high cellularity with predominance (95%) of non-degenerate neutrophils and CSF cytology showed a mild amount of red blood cells with occasional lymphocytes and monocytes.
The results for Toxoplasma and Neospora serology were negative, Borrelia serology was positive, Anaplasma and Borrelia PCR of the synovial fluid were negative, antinuclear antibody titer (ANA test) was not identified. Therefore, therapy with glucocorticosteroid (2 mg/Kg once a day) and doxycyline (10 mg/Kg once a day) was started.
After 48 hours all the clinical signs improved and the patient was discharged.
Idiopathic immunemediated polyarthritis (IMPA) is by far the most common form of nonerosive polyarthritis and is categorized in four subtypes.
Type II (reactive) is described as the result of an infectious or inflammatory disease distant from the joints and is reported in about 13-25% of idiopathic IMPA.
Borreliosis has been stated as a cause of polyarthritis, in which the pathogenic mechanism consists of the deposition of immune complexes within the synovium, leading to sterile synovitis.
Up to 28% of dogs exposed to ticks in the UK have a positive antibody-type to B.burgdorferi, but a recent study has proposed a higher prevalence.
Although high levels of serum anti-Borrelia antibodies are not diagnostic for canine Lyme disease, in our case the association with the clinical signs and synovial fluid cytology helped to confirm the diagnosis.
In literature an association between pancreatic inflammation and Borreliosis has never been reported, but on the other hand pancreatic disease has been advocated as a cause of reactive IMPA.