A 5-year-old female African penguin presented with primary right limb paresis the day after laying a normal egg. She was alert and responsive but unable to stand. Withdrawal, conscious proprioception and deep pain were absent in the right leg. Radiographs were unremarkable; bloodwork showed heterophilic leukocytosis, hyperglycemia, hypernatremia, and elevated AST and CPK. CT and MRI the same day were unremarkable. Post-procedure the right leg was notably cold with no palpable pulse thus vascular compromise or an intravascular event was suspected. Supportive care was initiated and within days circulation to the right foot was restored. Mobility improved but neurologic deficits distal to the knee persisted. She simultaneously developed a cough; radiographs showed a right-sided pulmonary nodule and bloodwork showed worsening heterophilic leukocytosis. Antibiotic and anti-fungal treatments were started.
Mobility slowly improved but respiratory signs worsened, thus nebulization therapy was initiated. Tracheoscopy three weeks post-presentation revealed two small nodules proximal to the bifurcation; antimicrobials were adjusted based on culture and sensitivity results. Respiratory signs persisted and appetite and weight declined. Tracheoscopy 6 weeks post-presentation showed a 1-cm left-sided tracheal wall plaque proximal to the bifurcation, and a solid tissue band occluding the right trachea several centimeters distal to the bifurcation. A 5-cm right tracheal segment had increased density on radiographs. A severe mixed bacterial population was noted on cytology and culture; antimicrobial treatments were adjusted. Additional procedures were performed to remove pyogranulomatous material from the right trachea and treatments continue. Minimal neurologic deficits persist in the right foot.
We are very grateful to the Blue Pearl-Georgia Veterinary Specialists neurology, radiography and internal medicine clinicians and technical staff, as well as Drs. Steven Divers, Rodney Schnellbacher and Laila Proenca and technical staff from the University of Georgia Athens for their outstanding assistance with this case.
* Presenting author