Successful Management of a Dog with Protein-Losing Enteropathy and Concurrent Protein-Losing Nephropathy with Repeated Fecal Microbiota Transplantation

Protein-losing enteropathy (PLE) is a spectrum of gastrointestinal disorders in which protein loss occurs through the gastrointestinal tract. One of the underlying causes is chronic inflammatory enteropathy (CIE). Conventional therapies for CIE often include diet, immunosuppressives, anti-microbials, probiotics, and, recently, fecal microbial transplantation (FMT). This case report highlights the use of lyophilized material-based FMT through oral capsules and enema in a dog with PLE and concurrent protein-losing nephropathy (PLN). The patient initially had a significantly increased dysbiosis index (DI) and required repeated FMT treatments, resulting in a positive clinical response through improvement in body weight, serum albumin concentrations, fecal scores, and normalization of the DI over time. To maintain clinical responses, FMT had to be performed monthly. Approximately 1 year after starting FMT therapy, the patient then developed an episode of acute hemorrhagic diarrhea syndrome (AHDS) associated with netF-gene-encoding Clostridium perfringens strains, after which the DI became abnormal again. The patient responded clinically well to monthly FMT treatments again, but it took several months for normalization of the DI after the AHDS episode. In summary, this case report highlights the continued use of adjunct lyophilized FMT in a dog with PLE resulting in improved clinical control over time.