Student Case Presentation
Udder Consequences: Perimammary Necrotising Fasciitis in a 4 year old Dairy Cow
| Date/Time: |
9/12/2024 15
|
| Presenter: |
Alyx Trulsen |
| Veterinary School: |
COR |
Abstract:
A 4 year old, dry, Holstein Jersey cross cow presented for a large, firm swelling located in the supramammary lymph node region of the hind right quarter of the udder in August 2023. The mass was ultrasounded and aspirated revealing a light brown opaque fluid. The remainder of the physical exam was within normal limits.
Over the next 48 hours, the swelling doubled in size, and the cow developed clinical signs including pyrexia, lethargy, anorexia, and discomfort. She was prescribed ampicillin once a day for 5 days and flunixin meglumine twice a day as needed for fever reduction. The swelling continued to increase in size, by 96 hours post presentation a mild subcutaneous emphysema had developed. The udder color changed to have a green hue pigmentation. Swelling was also observed along the ventral abdomen. Diffuse urticaria was noted over both flanks, and a mild left sided epistaxis was noticed. Ampicillin and flunixin meglumine treatments were extended to 7 days duration. By 120 hours, the udder swelling, subcutaneous emphysema, and ventral swelling continued to worsen. The area of green udder pigmentation enlarged to encompass the majority of the right hind quarter. Skin peeling and exudate were noted. The cow’s condition and attitude continued to deteriorate as the swelling moved cranially. The decision was made to euthanize the cow by penetrating captive bolt and necropsy was performed. Postmortem findings included a perimammary abscess with necrosuppurative fasciitis, and truncal edema. Bacteriology confirmed presence of Truperella pyogenes. While speculative, this was likely an unintended consequence of iatrogenic penetrating trauma leading to the inoculation of bacteria. The edema, severe fasciitis, and other clinical signs can likely be attributed to the rupture of the abscess and hematological spread of bacteria leading to sepsis.
