Coagulopathic manifestations as a primary presentation of canine angiostrongylosis: a retrospective case series

Objective: To describe the clinical presentations, diagnostic findings, and treatment outcomes of 3 dogs with atypical, predominantly coagulopathic manifestations of Angiostrongylus vasorum infection and to highlight the associated diagnostic challenges. Animals: 3 client-owned dogs presented at a veterinary referral hospital in Flanders, Belgium, between March 2018 and April 2022. Cases were eligible for inclusion if coagulopathic manifestations were a predominant component of the clinical presentation and canine angiostrongylosis diagnosis was confirmed. Clinical Presentation: The 3 included dogs were male and aged 8 months, 1 year, and 5 years. They presented with clinical signs attributed to hemarthrosis, intracranial hemorrhage, or both, with onset and progression varying among patients. Respiratory signs were absent in 1 dog and mild in 2 dogs, and initial diagnostic considerations included primary orthopedic or neurological disease. Results: All dogs exhibited coagulation abnormalities consistent with consumptive coagulopathy, including thrombocytopenia, prolonged clotting times, and/or increased D-dimer concentrations. Infection with A vasorum was confirmed by serological antigen detection and/or fecal Baermann examination. Imaging findings included joint swelling, intracerebral hemorrhage, and mild interstitial pulmonary changes. Treatment consisted of anthelmintic therapy with adjunctive corticosteroids, and 2 dogs received plasma transfusion. All dogs recovered with resolution of clinical signs and normalization of laboratory abnormalities. Clinical Relevance: These cases highlight the importance of including canine angiostrongylosis in the differential diagnosis for dogs presenting with unexplained coagulopathy or hemorrhage, even in the absence of respiratory signs, particularly in regions where the parasite is emerging. Early diagnosis and treatment are critical to prevent potentially life-threatening complications.