Case report highlights TPE in Chihuahua after centipede envenomation

A newly posted case report in Frontiers in Veterinary Science details a rare escalation from a centipede sting to systemic illness in a 2-kg Chihuahua, and the clinicians’ decision to use therapeutic plasma exchange as a rescue treatment. According to the report, the dog presented after a sting to the interdigital region of the right forepaw and went on to develop lameness, red urine, icteric mucous membranes, suspected hemolysis, inflammatory changes, tissue injury, and hepatocellular damage despite initial supportive care. After membrane-based TPE, the dog improved and was discharged after seven days. (frontiersin.org)

That makes the report notable on two fronts. First, most centipede envenomation discussions center on pain and local tissue effects, not advanced extracorporeal support. Second, TPE in veterinary medicine is still concentrated in referral and specialty settings, where it’s more commonly discussed for highly protein-bound toxicants, selected immune-mediated diseases, and other severe intoxications. Recent clinical overviews from specialty centers describe growing use of extracorporeal therapies in veterinary toxicology, but they also underscore that these treatments remain resource-intensive and highly case-dependent. (mspca.org)

The case details help explain why the team escalated. In the Frontiers report, estimated plasma volume was 96 mL, and the prescribed exchange volume was 134 mL, or 1.4 plasma volumes. Roughly 1,080 mL of whole blood was processed over three hours using a 68-mL extracorporeal circuit primed with whole blood, heparin anticoagulation, and fresh frozen canine plasma as replacement fluid. The authors reported transient asymptomatic ionized hypocalcemia, treated with calcium gluconate, but otherwise described the procedure as well tolerated despite the patient’s size. C-reactive protein fell from 8.9 to 1.5 mg/dL after treatment, appetite returned, and the dog subsequently recovered. (frontiersin.org)

The broader TPE literature gives some context for why this may draw attention from emergency and critical care teams. Specialty reviews note that TPE is generally considered when a harmful substance or circulating factor is large, highly protein-bound, or otherwise poorly addressed by standard supportive care alone. Veterinary reports and reviews have described TPE for NSAID overdoses, pyrethroid intoxication, bilirubin-associated neurologic disease, and selected immune-mediated conditions. A recent clinical review from MSPCA-Angell also notes that advanced extracorporeal toxicology care has expanded since 2015 as equipment access and clinician experience have grown. (mspca.org)

There doesn’t appear to be much published expert commentary yet on this specific centipede case, but the industry trend line is clear: extracorporeal therapies are moving from niche rescue tools toward a more established part of specialty toxicology and critical care. At the same time, the evidence base is still built heavily on case reports, case series, and retrospective data, which means enthusiasm is tempered by practical realities. Even among centers that offer TPE, patient size, vascular access, anticoagulation management, blood product availability, monitoring capacity, and clinician expertise all shape whether a case is truly a candidate. (mspca.org)

Why it matters: For veterinarians, this report is less about centipedes specifically than about thresholds for escalation in uncommon toxicologic emergencies. A dog with persistent pigmenturia, suspected hemolysis, and multi-organ involvement after envenomation may need a different mental framework than the usual “local sting, supportive care, monitor” approach. The case also matters because it shows that membrane-based TPE can be technically feasible in a 2-kg patient, which may influence how referral teams think about toy-breed eligibility for extracorporeal support. Still, clinicians should be careful not to overread a single successful case: the report shows temporal association and procedural feasibility, not proof that TPE was necessary, superior, or broadly generalizable. (frontiersin.org)

What to watch: The next meaningful step would be more published cases, ideally with clearer toxicologic characterization, timing of intervention, and outcome comparisons against intensive supportive care alone. If similar reports emerge, they could help define when systemic arthropod envenomation crosses the line from conventional management to referral for extracorporeal therapy, and whether TPE should be considered earlier in dogs showing hemolysis or rapidly evolving organ injury. (frontiersin.org)