Successful Treatment of Disseminated Nocardiosis Caused by Nocardia veterana in a Dog

Yaemsiri, S.; Sykes, J.E.

The dog was treated in hospital for 10 days with TMS (30 mg/kg IV q12h), prednisone (0.6 mg/kg, PO q24h for 5 days and then 0.3 mg/kg PO q24h), methadone (0.17 mg/kg IV q6h) postoperatively, and maropitant i (1 mg/kg IV q24h). Four days after anesthesia, clinical signs suggestive of esophagitis developed that included gagging and odynophagia. Treatment with pantoprazole j (1mg/kg IV q12h) and sucralfate (60mg/kg PO q8h) were initiated with complete resolution of clinical signs within 2 days. The dog was discharged from hospital with instructions to the owner to treat with TMS (29 mg/kg PO q12h) and to taper the course of prednisone (0.3 mg/kg PO q48h for 7 days then discontinue). Trimethoprim-sulfamethoxazole was continued for a total of 3 months with gradual improvement in the right thoracic limb lameness, skin lesions, the inflammatory leukogram, liver enzyme activities and hyperbilirubinemia. During this time, serum cholesterol concentrations were markedly elevated (at peak, 931 mg/dL, RR 139-353 mg/ dL) despite discontinuation of prednisone. Within 1 month of TMS discontinuation, all biochemical variables had returned to within normal limits. Aerobic and anaerobic bacterial blood cultures were performed 1 month after discontinuing TMS and were negative. Two months after discontinuation of antimicrobial drugs, the dog was re-evaluated for an acute onset of reluctance to walk and lumbosacral pain. An MRI revealed a right-sided L3-4 intervertebral disk herniation. There was complete recovery after a second hemilaminectomy. No other clinical signs of disseminated nocardiosis or IMPA have developed in the year since discontinuing antimicrobial and immunosuppressive drugs.