WHAT THE HECK IS GOING ON? We definitely asked the same question when he came into the clinic. Initially, I thought ‘this looks like a dog with an anaphylactic allergic reaction’ so we gave him a dose of steroids and diphenhydramine to stop the reaction. He had a very high fever (40.9C), his heart rate and rhythm was normal (120bpm), and his respiratory rate was within normal limits (20bpm). He was able to oxygenate his body adequately. His physical exam was relatively unremarkable apart from his fever and the severity of edema present in his face.
Once we got ahold of the current owners, we found out that this has been going on for a few days and that he did get porcupine quills removed a couple weeks back. Typically, anaphylactic reactions do not stick around for this long - patients will either die, get treatment, or, if minor, the reaction will resolve on its own. With the degree of swelling in this pups face and the history, we were less suspicious of an allergic reaction but could not completely remove it from our differential list.
We hooked him up to IV fluids and gave him some pain medication. Next, we aspirated the face to collect fluid/cells. A minimal amount of watery/bloody (serosangenous) fluid was aspirated into the hub of my needle. Under the microscope, the fluid was not very cellular. It had mild amount of red blood cells and a few basophils (a type of white blood cell). His bloodwork was pretty unremarkable. It showed that he was mildly dehydrated (hemoconcentration) and was stressed (mild hyperglycemia/ high blood sugar). I put an ultrasound probe on the facial swelling to see if I could possibly see if there were areas that looked like abscesses. But, the facial tissue appeared to look like edematous tissue with some very large lymph nodes.
I was a little stumped. With the history of having quills removed, I was suspicious that he may have a migrating quill abscess that could be contributing in some way to his clinical signs so I started him on IV antibiotics. He was stable and comfortable in his kennel. We decided we would give it some time to see how he would respond to our initial treatment while we do some more research.
This morning, we came back in to the clinic to find that the swelling had ruptured out of the front of his neck. There was a serum/ blood tinged fluid (serosangenous) viscous fluid with white flakes of fibrin in it. The ruptured skin revealed a massive pocketed area that had probably been a abscess festering. The skin and some of the tissue surrounding it was quite dead. (NOTE: this was not noticeable the day before. Starting treatment can help force abscess to rupture.)
I put the dog under general anesthesia to remove the dead tissue. While cleaning and debriding the area, a quill was found!! This quill must have been imbedded too deep to be seen at quill removal or broken off so it was unable to be removed (this is why you should never cut quills; they always need to be pulled). I removed as much tissue as I could without hitting the jugular vessel (I could see it!) and placed two drains to allow continued drainage.
SO, WHY THE FACIAL SWELLING? We suspect that the quill migrated to form an abscess deep in the neck. The abscess caused so much pressure in this area that it could have blocked off lymphatic (lymph node) drainage and/or caused ineffective venous (jugular) drainage of blood. This can be one of the causes of edema to form because of increased hydrostatic pressure (starling forces).
This is what we speculate! So, if you have any other ideas, feel free to comment He is doing much better and the swelling in his face has decreased SIGNIFICANTLY! Saving Grace Animal Society
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