Liposarcoma (LPS) typically occurs in the extremities and retroperitoneum, but rarely occurs in visceral organs such as pancreas. Only few cases of primary pancreatic LPS have been reported in literature. Here we describe the first case of primary pancreatic LPS in a patient receiving continuous ambulatory peritoneal dialysis (CAPD). This patient was a 60-year-old female who had been on CAPD for 3 years due to kidney failure from type 2 diabetes mellitus. She presented with a 2-week history of intermittent fever measuring up to 38 degrees Celsius. The septic workup including peripheral blood, peritoneal dialysis (PD) fluid, urine, and sputum cultures were all negative. Intravenous piperacillin/tazobactam was empirically started but there was persistent fever with increasing blood leukocytosis (blood white cell count up to 37.5×10[9]/L). In addition, she developed cloudy peritoneal dialysate, suggestive of PD peritonitis, 2 weeks into the hospitalization. Piperacillin/tazobactam was then switched to intravenous meropenem and intraperitoneal vancomycin. Computerized tomography scan of the abdomen showed a large heterogeneous enhancing mass with central hypoattenuating area arising from the pancreatic tail. There were also local invasion and multiple metastatic lesions. Ultrasound-guided fine-needle biopsy of the abdominal mass confirmed the diagnosis of primary dedifferentiated LPS of the pancreas. In view of the advanced nature of the disease, she was treated with palliative chemotherapy. Her clinical condition deteriorated progressively and she passed away from pneumonia 10 months after the diagnosis of LPS. Our case shows that patients on CAPD with pancreatic LPS can develop symptoms mimicking infectious peritonitis and also highlights the importance of considering malignancies in the differential diagnosis of fever and unexplained leukocytosis after ruling out infective causes.

Urinary cystatin B (uCysB) is a biomarker of kidney injury in dogs and cats. A high-throughput agglutination immunoassay (Idexx Laboratories) was developed for widespread commercial availability of uCysB testing in a reference laboratory setting. We evaluated immunoassay performance and included analyses of precision, accuracy, linearity, interference, analytical specificity, lot-to-lot variation, and stability. CVs from precision studies on the range of 50-500 ng/mL were 0.38-2.53% (canine) and 0.44-3.5% (feline) for within-run precision, and 1.49-5.09% (canine) and 0.65-5.05% (feline) for between-run precision. Accuracy was measured by recovery percentage and was 89-101% (canine) and 91-112% (feline). Amoxicillin, ciprofloxacin, low concentrations of doxycycline, bilirubin, glucose, ketones, RBCs, hemoglobin, cloudiness, lipids, protein, and pH did not affect results. Urinary cystatin A did not cross-react with the uCysB immunoassay. Results of lot-to-lot linear regressions were 0.90-1.07 (slopes) and 0.97-1.00 (coefficient of determination). One or more freeze-thaw cycles and storage at 30°C impacted the immunoassay stability of canine samples but not feline samples under the same conditions. Our results validate this novel agglutination immunoassay for accurate and precise measurement of uCysB in canine and feline urine samples. For optimal immunoassay performance, samples should be kept at 4°C for a maximum of 1 wk. Our uCysB immunoassay is a useful and practical tool to be used in assessing kidney injury in canine and feline patients in the clinical setting.

Chyluria is a rare clinical entity defined by the presence of chyle in the urine, classically presenting as milky or cloudy urine. While typically associated with parasitic infections such as Wuchereria bancrofti in endemic regions, non-parasitic causes are less common and diagnostically challenging. We report the case of a 56-year-old male presenting with milky urine, dysuria, urinary hesitancy, and rectal discomfort. Urine triglyceride level was found to be >525 mg/dL (reference range <10 mg/dL). An extensive infectious and parasitic workup was negative. Renal biopsy revealed minimal change disease (MCD), a highly unusual finding in adult-onset chyluria. Although MCD does not cause chyluria, coexisting disease can contribute to urinary protein loss. This case highlights the importance of maintaining a broad differential diagnosis when evaluating urinary discoloration and emphasizes the rare intersection between glomerular disease and lymphatic-urinary communication. Early recognition of atypical presentations is essential to guide appropriate evaluation and prevent complications associated with chronic chyle loss.

The aim of this study was to evaluate the effect of different water restrictions on the thermoregulation and blood hematological and metabolite parameters of crossbred Santa Inês ewes in a semi-arid climate. Thirty-two ewes were subjected to four water supply levels (100%, 80%, 60%, and 40%), in a completely randomized design with eight replications. The confinement period lasted 77 days, with 14 days allocated for adaptation. Respiratory rate, heart rate, and rectal temperature exhibited a quadratic response. There was an increase in red blood cells and urea. The enzyme alanine aminotransferase decreased linearly with water restriction. Urinary creatinine decreased along with water supply. Regarding urine color characteristics, all groups showed different colors, ranging from clear to cloudy. For the chemical characteristics of urine, a quadratic effect was observed for pH, with the highest value (8.75) at 60%. An increase was observed in total urine proteins and urobilinogen. Crossbred Santa Inês ewes in a semi-arid climate exhibit physiological adaptations to water supply reduction up to 40%. Following an 80% reduction in water supply, animals exhibit mild dehydration, characterized by increased serum urea levels and decreased alanine aminotransferase activity.

Amoxicillin crystalluria (AC) refers to the precipitation of amoxicillin in the urine as amoxicillin trihydrate crystals. Amoxicillin-induced crystal nephropathy (AICN) refers to the obstruction of kidney tubules by amoxicillin trihydrate crystals, resulting in acute kidney injury. Usually considered rare and not serious, AC and AICN would be more frequent in patients receiving high-dose i.v. amoxicillin (≥150 mg/kg per day) than previously reported. AC prevalence ranges from 24% to 41%. AICN prevalence remains unclear. AC is generally asymptomatic, but sudden macroscopic hematuria with cloudy urine suggests the diagnosis. AC is diagnosed by detecting amoxicillin trihydrate crystals in urine. AC is a risk factor for acute kidney injury. Diagnosing AICN is more challenging in the absence of noninvasive diagnostic tools. It is suspected in high-dose i.v. amoxicillin-treated patients who develop acute kidney injury and AC, and after excluding other causes of acute kidney injury (mainly sepsis and acute interstitial nephritis). When testing for AC is unavailable, the presence of demonstrated (high blood amoxicillin levels and low urinary pH) or suspected (rapid i.v. amoxicillin administration and hypovolemia) risk factors for AC suggests its diagnosis. AICN management includes discontinuation/reduction of amoxicillin doses and volume resuscitation to improve tubular flow and urine output and decrease amoxicillin supersaturation. Patients generally recover normal kidney function rapidly after stopping amoxicillin, but renal replacement therapy is required in 10%-40% of patients. No deaths have been directly attributed to AICN. Future studies are needed to assess the exact prevalence of AC/AICN and to define optimal therapeutic options.

A 7-year-old castrated male poodle was brought to the referral Animal Medical Center and diagnosed with diabetes and pancreatitis. One month later, the patient presented with cloudy urine, and ultrasonography revealed a large number of spherical substances. The patient was subsequently diagnosed with fungal cystitis with Candida albicans. Initially, 10.00 mg kg[-1] itraconazole was prescribed twice daily for six weeks, and the symptoms of prolonged urination improved; however, the fungal balls persisted in the bladder. The six months later, the patient showed recurrent symptoms, such as dysuria and stranguria; therefore, 5.00 mg kg[-1] fluconazole was prescribed twice daily; however, it was not effective. Subsequently, 1.00 mg kg[-1] caspofungin once daily was administered for three consecutive days. Finally, the fungal balls in the bladder disappeared. The patient was regularly monitored after completion of treatment and, 17 months later, doing well without recurrence. Few reports exist on the use of caspofungin in veterinary medicine. The recommended dose of caspofungin in dogs remains unknown. In the case of azole-resistant Candida, treatment using caspofungin should be considered; although, additional studies on the established dosing and side effects are needed.

A 76-year-old female patient with a history of rheumatoid arthritis, Sjögren syndrome, and hypertension presented with headache, fever, and dysphagia. The patient was taking prednisone and leflunomide to treat rheumatoid arthritis. The headache was primarily left sided and occasionally radiated to the occipital region. The patient had a high-grade fever spike, with a temperature of 104 °F (40 °C). Results of a prior lumbar puncture and temporal artery biopsy from an outside hospital were negative. Findings of a neurologic examination were unremarkable. Oropharyngeal examination for dysphagia revealed minimal pharyngeal motility, with pooling of food in the pharynx, which was thought to be due to cranial nerve dysfunction. Laboratory analysis revealed that, except for anemia, complete blood count parameters were within normal limits. C-reactive protein level (49.7 mg/L; reference range, 0.0-8.0 mg/L), erythrocyte sedimentation rate (>140 mm/h with Westergren method; reference range, 0-27 mm/h), and brain-type natriuretic peptide level (145 pg/mL; reference range, 0-100 pg/mL) were elevated. Blood and urine cultures were negative. A lumbar puncture was performed, which revealed cloudy cerebrospinal fluid (CSF), with an elevated CSF protein level (78 mg/dL; reference range, 7.0-35.0 mg/dL) and a low CSF glucose level (37 mg/dL [2.05 mmol/L]; reference range, 45-70 mg/dL [2.50-3.89 mmol/L]); otherwise, CSF encephalopathy, an autoimmune panel, and cultures were negative. CT and MRI of the brain with paranasal sinus were performed. Nasal endoscopy-guided drainage of the preclival fluid collection was performed, and biopsy of nasopharyngeal tissue was performed. Fluid culture revealed the growth of Candida albicans, as well as Pseudomonas and Enterobacter aerogenes. The patient received fluconazole, ceftriaxone, vancomycin, and metronidazole. Follow-up MRI was performed after 2 weeks.

A 3.5-year-old intact male Labrador retriever was seen for hematuria. The results of clinical pathology tests were unremarkable. However, urinalysis revealed dark, cloudy, alkalotic, and isosthenuric urine containing red and white blood cells, epithelial cells, and struvite crystals. Severe bilateral enlargement of ureters and markedly enlarged kidneys were identified on abdominal radiographs. Computerized tomography revealed extensive bilateral hydroureteronephrosis with no definitive cause of obstruction. The dog underwent bilateral ureteral tapering with bilateral neoureterocystostomy and placement of temporary bilateral ureteral stents and a cystostomy tube. The dog was monitored in the intensive care unit for 7 d after surgery and was discharged 9 d after surgery and after the stent and cystostomy tube were removed. The dog remained clinically normal and was reported to have been euthanized at 11 y of age (2021) due to unspecified causes. Key clinical message: There are several potential causes of severe bilateral hydroureteronephrosis in animals. Based on this case report, dogs with severe bilateral hydroureteronephrosis that are clinically asymptomatic may have favorable outcomes following bilateral ureteral reconstruction and neoureterocystostomy, even if a definitive cause is not identified.

A 76-year-old woman with a history of rheumatoid arthritis, Sjögren syndrome, and hypertension presented with a headache, fever, and dysphagia. The patient was taking prednisone and leflunomide to treat rheumatoid arthritis. Her headache was primarily left sided and occasionally radiated to the occipital region. The patient had a high-grade fever spike, with a temperature of 104°F (40°C). Results of a prior lumbar puncture and temporal artery biopsy from an outside hospital were negative. Findings of a neurologic examination were unremarkable. Oropharyngeal examination for dysphagia revealed minimal pharyngeal motility, with pooling of food in the pharynx, which was thought to be due to cranial nerve dysfunction. Laboratory analysis revealed that, except for anemia, complete blood count parameters were within normal limits. C-reactive protein level (49.7 mg/L; reference range, 0.0-8.0 mg/L), erythrocyte sedimentation rate (>140 mm/h with Westergren method; reference range, 0-27 mm/h), and brain-type natriuretic peptide level (145 pg/mL; reference range, 0-100 pg/mL) were elevated. Blood and urine cultures were negative. A lumbar puncture was performed, which revealed cloudy cerebrospinal fluid (CSF), with an elevated CSF protein level (78 mg/dL; reference range, 7.0-35.0 mg/dL) and a low CSF glucose level (37 mg/dL [2.05 mmol/L]; reference range, 45-70 mg/dL [2.50-3.89 mmol/L]); otherwise, CSF encephalopathy, an autoimmune panel, and cultures were negative. MRI and CT scans of the brain with paranasal sinus were performed (Figs 1-3). Nasal endoscopy-guided drainage of the preclival fluid collection was performed, and biopsy of nasopharyngeal tissue was performed. Fluid culture revealed the growth of Candida albicans, as well as Pseudomonas and Enterobacter aerogenes. The patient received fluconazole, ceftriaxone, vancomycin, and metronidazole. Follow-up MRI was performed after 2 weeks (Fig 4).