Question: Based on the CSF slide images and analysis, what type of inflammation is this?
LAB TITER RESULTS: Lab titers were negative for common causes of infectious meningitis (valley fever, tick fever, toxoplasmosis and cryptococcis).
Diagnosis: Severe meningoencephalomyelitis of unknown etiology (MUE) but presumptively immune-mediated based upon exclusion of neoplastic and infectious etiologies and similarity to other reported cases.
Treatment: Because of the severity of this patient's presumed immune-mediated meningomyelitis, immunosuppressive treatment with lomustine was initiated, as it is a fast-acting immunosuppressant. Prednisone was recommended to assist in decreasing inflammation around the spinal cord, as well as the neuropathic pain medication gabapentin. Lab work was submitted after each lomustine dose to monitor the patient's tolerance of the drug.
Outcome: This patient has improved with each dose of lomustine and no longer requires pain medication, but must continue to be monitored closely as relapse can occur at any point during or after treatment. The prognosis is good as long as the patient continues to improve throughout treatment over the course of a year, but the patient should be followed for evidence of remission.
Case Discussion: This patient presented with classic signs of cervical neck pain. A Dachshund presenting with cervical pain can typically be attributed to Type I Intervetebral Disk Disease. However, there are other differential diagnoses for cervical pain in a Dachshund. High-quality advanced imaging was necessary to reach a diagnosis in this patient. It is important to recognize the limitations of different imaging modalities, as this patient’s severe meningitis would have been overlooked with CT and myelography would likely have been detrimental.