Dog with unilateral dual nasal infection and eye ulcer... both not improving. Help!

• Species: Dog

• Age: 13.5 years

• Sex: Mail, neutered

• Breed: Mix (dachshund, rottie, lab?)

• Weight: 55 lbs

• Clinical: Unilateral dual nasal infection and recurring eye ulcer - not healing/improving

• Duration: Approx. 5 weeks

• Location: New England area

• Mental state: Normal - no issues going to the bathroom, eating, etc.

• Routine Meds: monthly Librela injection for his back pain and shaky back legs

• CT Scan and Histopathology results are at the bottom of this post

Hello - I'm looking for advice on how to help my pup and what we should do next. His regular vet says she's never seen what's going on with my dog before. He started having an issue with his left nostril in early June. It is blocked constantly with hard, crusty discharge (it looks yellow-ish). He went to his regular vet a few times and they remove hard chunks out of his nose, but within a day or two it would fill back up. A few days or so after this started he started jerking his head back and wincing in pain. I took him to an internal medicine vet who performed a CT scan, rhinoscopy, biopsies, and cultures (results are below). His biopsies came back showing he has a "Staphylococcus pseudintermedius - Few" and "Mycoplasma spp." infection wayyy back in his nose. She said it looked inflamed too. No fungal infection. CT did not find any tumors or anything overly concerning (results below). He has been on 125mg BID of Doxycyline Hyclate since June 19th.

I ended up taking him to his regular vet a few days after his internal medicine visit and they discovered he has a left eye ulcer. He was having a lot of milky white/yellow-ish thick discharge from that eye. He was first put on "Neomycin and Polymyxin B sulfates and Bacitracin Zinc Opthalmic Ointment" and "Oculenis" drops three times a day. He was given Imuquin packets to put in his food once a day. He was going into the vet every few days to monitor the ulcer... it wasn't healing at first so they added in donor plasma eye drops 5x a day and "Soothe Lubricant Eye Ointment" throughout the day. His eye ulcer ended up being "99%" healed, meds were stopped 3 days after the "healing". A week later, his eye ulcer is back. He is squinting, pawing, and rubbing his eye on everything and anything he can (he gets the "cone of shame" when he's pawing or rubbing). He had a Schirmer tear test twice and it showed moderate dry eye... I apologize I can't remember the exact result number. He was diagnosed with chronic dry eye and has now been given "Optimmune" twice a day and we were told to start him back up on the earlier mentioned Neomycin ointment twice a day.

His nose is not any better and it is still filling up with discharge and his left eye ulcer has returned. The vet wanted him to come back again to check the ulcer (fluorescent drops?) in 2-3 days after his tech appointment for the Schirmer test. We have spent thousands on my poor pup over the past 1-2 months to no avail. A few weeks we have spent upwards of $400-500 at the regular vet, the other weeks it has been $150-200. What is the correct direction to go in to help my poor guy out and heal/resolve his nose and eye? Are we missing something? If you got this far, thank you for reading and thank you in advance for any suggestions/advice/help you can give.

Histopathology report: DIAGNOSIS

Nasal cavity, left endoscopic biopsy: Mild lymphoplasmacytic rhinitis

Comment

Lymphoplasmacytic infiltration is a fairly non-specific inflammatory pattern in the nasal cavity, and may represent a response to inhaled foreign material, infectious antigen, adjacent neoplasia, or may occur as idiopathic rhinitis. Rare eosinophils are identified, the significance of which are unknown. No neoplastic infiltrate or infectious etiology is observed.

CT Findings: CONCLUSIONS

1. Mild mandibular lymphadenopathy, left. Considerations include primary reactive lymphadenitis.

2. Normal sinonasal cavities. There is no evidence of a mucosal mass, visible foreign material, or nasal discharge.

3. Equivocal regional white matter tract hypoattenuation. Left parietal lobe. Differential diagnoses include vasogenic edema subsequent to ischemic or metabolic abnormalities versus an imaging artifact. Corroboration with the patient's neurologic exam and mentation assessment is warranted. --- (in full report it explains: Brain: Subjectively, the gray-white matter definition is increased in the left parietal lobe (see series 6 images 32 through 44). In multiplanar reconstructions corrected for mild slice obliquity, this finding is less convincing." - was told this was probably due to an artifact during the scan?