Case report: did Freddy rabbit suffer from skin lymphoma ?
Celine Fischer – Esther van Praag
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My rabbit Freddy would have been 7 years old in January 2014. He suffers from chronic snuffles and was tested positive with Pasteurella multocida today. His buddy Tommy suffers a chronic Encephalitozoon cuniculi infection and is treated permanently with fenbendazole. he also has been diagnosed with an acute Pasteurella sp infection of the upper respiratory tract.
Freddy also suffers from itchiness and dandruff for a long time. A dermatophyte test returned negative. In addition to that – which is much worse – a lump appeared on his tummy in September. It developed suddenly and has now the size of a quarter dollar/1 euro coin. It has a crust on it and is slightly exposed (on the picture it looks wet as I'm supposed to use a cortisone-containing ointment).
Now my rabbit got little lumps all over his body, especially in parts of his body where he has a lot of dandruff:
At first there is dandruff, and then a little „pimple” appears, which gets covered by a crust. This crust becomes bigger and bigger. Besides those lumps in the skin, Freddy also had round, firm lumps that seem to be located deeper than the skin layer.
Anamnesis of Freddy
Mid 2013, Freddy started to have balance trouble and when he slept on the side or on his back he didn't manage to get up on his legs and I found him a few times on his back struggling or even giving in to get back up. He got Marbofloxacin (additional to his panacur medication) because we thought E. cuniculi would come back. After only a few doses, symptoms vanished and he hadn't had any problems with balance anymore.
Until a few days ago then he couldn't scratch with his hind legs again.
He had a really bad seizure in November when I brushed him. The seizure was really bad and his body got very stiff. It was not like an E. cuniculi seizure, raher epileptic and he remained fully conscious in my opinion. I read that rabbits sometimes experience seizures due to really bad itchinss, so I hoped this was the reason.
The skin symptoms started roughly end of November and got really worse and worsened within days. He lost like 250g within 1,5 months. Lumps with crusts did get a little flatter during the penicillin treatment, while the subcutaneous lumps without crusts kept spreading. Lesions started to grow on hisgenitals and hisface, and later on his back.
My two vets did not have an idea what Freddy suffered from and one decided to give antibiotics, suspecting treponematosis. Freddy got amoxicillin injections daily over 5 days. I fed him Bird Bene-Bac additionally. He already started to eat less before and ate only particular things like small pieces of celery because of those lumps on the right and left side of his (inside of the) mouth. Even the tongue was affected. But Freddy really wanted to live and was very energetic and curious.
I had to start feeding him with Critical Care eventually. He was really vibrant. Things changed on a Friday though - someone saw him standing there as if he were dizzy. At about midnight I realized his tummy was swollen and hard - apparently he had gas/gastrointestinal stasis. It was really bad and I thought we would lose him. I wanted to make him move and we discovered that he was unable to use his left forelimb. Within a little time he couldn't hop anymore.
The next day, Freddy was given the painkiller Metacam (he was in severe pain and crunched his teeth and was stretch his hindlegs away) and Nitroimidazol to fight the possible Clostridium sp. bacterium. At first he didn't poop anymore. But then, on Saturday night, he started to feel a lot better, his tummy flattened and at roughly 6 am, he urinated (finally!) and pooped a lot (normal feces).
He got to drink a lot of tea and water and we fed him with more critical care. He wanted to eat carrots and vegetables but he could only bite off a little piece, which he was unable to chew and swallow. Also he couldn't move his leg at all anymore. He hadn't urinated in a long time.
At midnight things turned worse. Freddy started to breath faster and deeper for some minutes, then back to normal. He was in pain and crunched his teeth. Kidney failure due to dehydration or E. cuniculi ? Toxins of the dying bacteria, as a result of injected amoxicillin ? Skin lymphoma and possible metastasis in his organs and lungs ?
Clinical characteristics of cutaneous lymphoma (lymphosarcoma)
The cutaneous form of lymphoma present different clinical features in rabbits and characteristic signs may be absent.
There is a non-pruritic rash, scaling of the skin, and thinning of the fur on the flanks, abdomen, and limbs and/or the appearance of firm erythematous plaques. At a later stage numerous subcutaneous swellings may develop. In several confirmed cases alopecia and hemorrhagic crusts covered the chin.
Peripheral lymph nodes may be enlarged or swollen, abdominal masses. Uveitis acute bilateral inflammation of the eyelid (blepharitis) may be present and may be accompanied by sero-sanguineous nasal discharge.
Skin lesions found on Freddy:
A skin biopsy can help confirm the diagnosis. Surgical biopsy is the preferred procedure when a lymph nodule is affected. if this is impossible, collection of a sample through needle aspiration accompanied by cytological examination and ultrasound are helpful tools in the diagnosis of lymphoma in rabbits.
Results obtained from a complete blood count test (CBC) of affected rabbits can be normal or it may show anemia, depressed hematocrit values, and an elevated BUN. Leukemia is sporadic.
Cutaneous lymphoma develops very rapidly, with the appearance of new nodules every day in different places of the body and in organs. Prognosis is poor.
No treatment for lymphoma is available in rabbits. In spite of different attempts to treat cutaneous lymphoma, there have been rapid relapses or death of the animal.
Freddy was relieved from his suffering on December 24th, 2013.