Fever of unknown origin. Cant figure out what is making her sick.

[Marinajanelle]

My four yr old german shepherd mix is sick for the third time since December. We have been to UC Davis three times without any answers as to what is making her so sick. 1st visit 12/22/16 2nd visit 2/21/17 3rd visit 3/8/17. At this point the possibilities we have left are 1) Infection. Possibly in her spine or bones. 2) Immune-mediated 3) Inflammation 4) cancer. She has taken fluids well and tolerated her ABX’s up until this go round. Her symptoms are the same every time.  1) Fever of unknown origin (usually 103+)  2) Lethargy periods (she perks up when you take her for walks, trips to the vet, outside and the neighbor dog comes outside) 3) Loss of appetite (this time more severe than previous) and she seems to not want to chew or put things in her mouth. We have also noticed that sometime in the last two weeks she has broken a tooth. She was eating her normal kibble until the fever started again.) 4) Not wanting to shake her head (like when dogs are wet to dry off) 5) diarrhea with mucus. Color is an orangy-reddish clay color. No clumps or strands of blood.  6) NEW SYPMTOM Mucus. She seems to be swallowing often almost like it is hard to get anything down. She vomited today about 30 min after giving her Baytril and it was a very thick mucusy foam. She also threw up last night about and hr and a half after giving her clavamox but that was just fluid. She has been prescribed Clavamox 375mg BID and Baytril 68mg 3tabs QD. Normally she tolerates these fine but she has not been eating or drinking like she normally does. I have been pushing fluids and have tried chicken/rice, wet dog food, bread soaked in milk, and bone broth and she doesn’t want to eat anything. I have had to force food to give her pills.
We have done blood work three times.
WBC’s 1)10,900 2)11,802 3)3,039
Metamyelocytes 1)109
Bands 1)654 2)1,180 3)760
Neutrophils 1)8,611 2)8,379 2)912
Monocytes 1)1,199 2)1,888 3)669
Platelets 1)112,000 2)122,000 3)314,000
Creatine Kinase 1)568 2)307
Alkaline Phosphatase 1)206 2)328
BUN 1)8 2)9
We’ve done a 4DX Snap test which was negative. Two Urine analyses were negative. Echo for Grade 1 heart murmur came back normal suggesting her murmur is physiologic. Chest xray was within normal limits as well as her spine. Abdomen ultrasound showed a mildly dark liver and mottled spleen. A liver aspirate showed inflammation from possible production of WBC’s. No infectious agents were noted. Final review is still pending. A blood culture is also pending.

[ginger899]

Maybe it is "Immune Mediated Neutropenia", which apparently is not common. I just read a little about it. It's odd that there is no sign of (bacterial) infection and other than low WBC and Neutrophils, blood-work is normal.

Ehrlichiosis or other Tick-borne infection occurred to me, but that I am certain would show up in the blood-work.

The only things I can think of (which I am sure you or the vet have already thought of) are:

Fungal or viral infection.
(I presume Parvo virus can be ruled out?)
Check Spleen. Sometimes spleen issues can cause dramatically low neutrophil and WBC.
Check bone marrow.

I am so sorry she is so unwell. I really hope a solution can be found, and some treatment to make her more comfortable, at least.

[ginger899]

I must advise you that answers you will receive are not from a qualified veterinarian. There was a time when vets used to pop in here from time to time but I haven't seen them around for a long time.
Any advice you get is likely to be from a lay-person, or someone who has experience, with their own dog/s of the same thing.

I wonder if this could be a systemic infection from a diseased tooth? It doesn't take a great deal for an abscessed tooth to create a fever and systemic infection. I have had one myself and was WAY too stoical about it. I only got real help when I began to feel like I was passing out and suddenly felt dire.
Has the vet investigated that possibility? An X ray of the tooth roots might help. In which case an extraction and possible antibiotics might be the solution?

[Marinajanelle]

Thanks for the heads up. We have spent many days at UC Davis trying to figure out what is wrong with our poor girl. They are thinking it is immune mediated as she has been on 3 different antibiotics and has relapsed multiple time. One time while she was going on week 3 of treatment. We have checked everywhere we can think of and there is no trace whatsoever of bacteria. We even did a culture of her blood that came back perfectly fine. Our issue is that her white blood cells, particularly her neutrophils, are really low. We started tramadol and fluids under the skin yesterday as she has swelling in her Carole joint that shows pain and steroids this morning. She has had some incontinence issues since last night that became more frequent this evening. We are discontinuing the tramadol and fluids to see if that resolves our issue...