December 2017

Signalment (JPC #1923797):  German shepherd dog military working dog (MWD)

HISTORY:  This MWD presented with anorexia, weight loss, and a painful abdomen.

HISTOPATHOLOGIC:  Kidney:  There is abundant interstitial hemorrhage and multifocally at the corticomedullary junction, arcuate vessel walls are markedly thickened and contain the following changes:, the endothelium is discontinuous and lost; the tunica media is effaced and replaced by abundant eosinophilic cellular and karyorrhectic debris admixed with fibrin, edema, and few inflammatory cells (necrotizing vasculitis); the tunica adventitia is thickened by edema, fibrin and fibrosis with moderate numbers of infiltrating lymphocytes, plasma cells, macrophages including epithelioid macrophages and few multinucleated giant cells (Langhans and foreign body type), and neutrophils that extend into the surrounding renal parenchyma. The lumina of several affected vessels contain fibrin thrombi admixed with few inflammatory cells and necrotic debris.  Within vessel lumina, vessel walls, multinucleate giant macrophages, and the perivascular connective tissue are moderate numbers of poorly discernible fungal hyphae with 4 – 6 um wide parallel walls, septations, and 15 um terminal bulbous structures.  Multifocally, effacing and replacing up to 50% of the medullary architecture in the section is the previously described pyogranulomatous inflammation admixed with similar fungal hyphae.  Multifocally remaining medullary and cortical tubules are widely separated by abundant edema, fibrin and hemorrhage.  Multifocally, tubules  exhibit one or more of the following changes: epithelium undergoing degeneration, characterized by pale and vacuolated cytoplasm and swollen nuclei; or necrosis, characterized by hypereosinophilic cytoplasm and shrunken, pyknotic nuclei ; tubule lumina are filled with an eosinophilic granular homogenous  debris (hyaline cast) admixed with small amounts of hemosiderin, and/or deeply basophilic material (mineral), or lumina contain sloughed necrotic epithelial cells admixed with necrotic debris (granular cast).  Glomeruli occasionally exhibit periglomerular fibrosis, hypertrophied parietal epithelium and synechia. The renal capsule is multifocally mineralized.

Gridley"s stain:  Diffusely, within foci of necrotizing vasculitis, there are abundant positive staining, septate fungal hyphae with acute angle, dichotomous branching, parallel walls of relatively uniform width (3 – 6 um), and up to 15 um bulbous dilations of the walls.

MORPHOLOGIC DIAGNOSIS: Kidney, corticomedullary junction: Vasculitis, necrotizing and granulomatous, multifocal, severe, with  numerous fungal hyphae and marked interstitial hemorrhage, pyogranulomatous nephritis, and tubular degeneration and necrosis, German shepherd dog, canine.

ETIOLOGIC DIAGNOSIS:  Renal aspergillosis

CAUSE:  Aspergillus terreus

CONDITION:  Systemic Aspergillosis











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