Faecal Occult Blood Test

Case of the Month (Emma Scurrell August 2012)

Lungworm infection associated with hypercalcaemia in a dog

A bronchoalveolar lavage (BAL) is performed in a 4-year-old crossbreed dog with a clinical history of coughing. Air-dried direct smears are made at the time of sampling and are submitted together with the EDTA fluid sample for cytological evaluation. Thoracic radiographs revealed an interstitial lung pattern and the dog is also mildly hypercalcaemic (both total and ionised calcium are increased).

Fig 1. The smears contain a large number of inflammatory cells dominated by macrophages and fewer neutrophils. Rare eosinophils are also present (red arrow).

Fig 2. Occasional multinucleated giant cells are noted (red arrow).

Fig 3.  Associated with the inflammatory cells are moderate numbers of often coiled nematode larvae, typical of Angiostrongylus vasorum (A vasorum) 

Final Diagnosis

A vasorum infection associated with pyogranulomatous pneumonia and hypercalcaemia


Hypercalcaemia associated with lungworm infection is not common but remains an important differential to consider in hypercalcaemic dogs. Hypercalcaemia secondary to granulomatous inflammation is well-recognised and is likely due to the dysregulation of calcitriol production by activated macrophages. BALs from dogs infected with A vasorum do not necessarily reflect eosinophilic inflammation and some cases are associated with a pyogranulomatous to granulomatous response with very few or no eosinophils. The calcium levels in this dog returned to normal following treatment for lungworm.

Previous Monthly Cases

Hypertensive Retinopathy January 2010
FIP in a cat - uncommon presentation February 2010
Phaeohyphomycosis    March 2010 
Scleral Rupture April 2010
Canine and feline epulides May 2010
Erythema multiforme in a labrador retreiver June 2010
Keloidal fibrosarcoma in a labrador retreiver July 2010
Cutaneous epitheliotropic lymphoma  August 2010 
Benign cutaneous histiocytoma  September 2010 
Iridociliary adenoma October 2010
Proliferative thrombovascular necrosis of the pinnae November 2010
Signet-ring cell carcinoma in the stomach of a dog December 2010
Cutaneous infiltrative lipoma in a labrador January 2011

Tonsillar squamous cell carcinoma February 2011
Canine orbital meningioma March 2011
"Lung-digit" syndrome in a cat April 2011
Hepatic amyloidosis in a cat May 2011
Haemophagocytic histiocytic sarcoma June 2011
Alternaria spp. infection in an immunocompromised dog July 2011
Ocular manifestation of lymphoma in a cat  August 2011
Kerion dermatophytosis in a Cocker spaniel September 2011
Subcuticular coenurus in a rabbit  October 2011
Optic nerve glioma in a dog November 2011
Malignant transformation of a viral papilloma in a dog  December 2011
Uveodermatological syndrome in an Akita
January 2012
Cutaneous angiostomatosis in a dog  February 2012
Transitional cell carcinoma in a dog  March 2012
Corneal inclusion cysts in a dog   April 2012
Extraskeletal osteosarcoma in a dog  (May 2012)
Subungual melanoma in a dog  (June 2012)
Retrobulbar grass seed in a dog   July 2012

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Faecal Occult Blood Test