History: Toby presented with a history of chronically soft stool but 1 month of intermittent watery diarrhoea, inappetance and lethargy which waxed and waned with antibiotics (Noroclav) and a diet change (Chappie). Investigations to date identified panhypoproteinaemia and low cholesterol with normal B12, folate and TLI.

Physical Examination: Toby weighed 29.5kg (BCS=4/9). He had full anala glads and gas in his colon but his examination was otherwise unremarkable.

Diagnostics: Toby’s protein concentrations have mildly increased (TP=54g/L, Alb=23g/L). An ACTH stimulation test is pending. Attempts to collect a faecal sample were unsuccessful.

Assessment: Toby’s differential diagnosis list includes atypical hypoadrenocorticism, giardia (still possible, despite negative faecal flotation), lymphangectasia, chronic colitis, dietary sensitivity (not ruled out by allergen panel), IBD or lymphoma. After discussing his improved protein levels and current apparent stability, we have elected to treat him symptomatically with metronidazole (400mg PO BID) and fenbendazole (50mg/kg SID x 3d) whilst his ACTH stimulation test is pending. Tramadol (100mg TID) has been dispensed in case his owners perceive a recurrence of his painful episodes.

If Toby’s cortisol production is normal and clinical signs recur then Toby will need upper and lower GI endoscopy to further investigate his problem and we plan to do this early next week in that eventuality.