A 10-year-old Labrador Retriever with what appeared to be common nasal symptoms was diagnosed with a rare and serious blood disorder, leading to a rapid decline. This case highlights the challenges of diagnosing and treating rare conditions like cryoglobulinemia and its association with multiple myeloma in dogs.

The Case: From Nosebleeds to a Complex Diagnosis The female neutered Labrador Retriever presented with epistaxis (nosebleeds), nasal discoloration, crusting, and a necrotic lesion on her lip. These symptoms alone may have seemed unusual but not alarming. However, when combined with bloodwork results showing pancytopenia (reduction of all blood cell types), azotemia (elevated blood urea levels), hypoalbuminemia (low blood albumin), and hyperglobulinemia (high levels of globulin proteins), veterinarians realized they were dealing with a far more complex issue.

A blood smear taken at room temperature revealed aggregates of amorphous basophilic material, which disappeared when the sample was warmed to 37°C. Additionally, a cryoprecipitate was noted in the dog's serum when chilled to 4°C. These findings indicated the presence of cryoglobulin, an abnormal protein that can lead to dangerous blood clots, especially in colder temperatures.

Key Diagnostic Tools: CT Scan and Cytology To further investigate, a computed tomography (CT) scan of the dog’s abdomen showed multiple heterogeneous lesions in the spleen. Cytology of these lesions confirmed significant plasma cell infiltration, consistent with a diagnosis of neoplasia (cancer). A bone marrow aspiration revealed that plasma cells made up around 38% of the total cellular population, an abnormally high percentage, further pointing to multiple myeloma, a type of cancer that affects plasma cells.

Serum protein electrophoresis also revealed a monoclonal spike in the gamma globulin region, a clear indicator of multiple myeloma.

Final Diagnosis: Multiple Myeloma and Cryoglobulinemia The combination of cryoglobulinemia and multiple myeloma was determined to be the cause of the dog’s initial symptoms. Cryoglobulinemia, an extremely rare condition often linked to lymphoproliferative disorders, can cause symptoms like nosebleeds due to hyperviscosity syndrome, in which thickened blood slows circulation and leads to abnormal bleeding or clotting.

Treatment and Outcome: A Rapid Decline The Labrador was given palliative care with prednisolone while the owner considered chemotherapy. Unfortunately, her condition deteriorated rapidly, and she was euthanized. The cryoglobulin precipitation and hyperviscosity syndrome were believed to have been responsible for the dog’s initial symptoms and rapid decline.

Clinical Relevance: Atypical Signs of a Rare Condition This case emphasizes the importance of considering rare conditions such as cryoglobulinemia when dogs present with unusual symptoms. It also underscores the value of thorough diagnostic testing, including blood smears, CT scans, and bone marrow aspirations, in reaching a conclusive diagnosis. Although cryoglobulinemia is uncommon in veterinary practice, this case demonstrates its potentially severe consequences when linked to conditions like multiple myeloma.

Veterinarians and pet owners alike should be aware that seemingly mild symptoms, such as nosebleeds or skin lesions, can sometimes signal a much more serious underlying condition.

Read full article here: Cryoglobulinemia Associated With Multiple Myeloma in a Dog Presenting With Epistaxis and Skin Lesions