1
|
Kim S, Kim Y, Kim HJ. Case report: Uncommon immune-mediated skin disease involving systemic disorders in dogs. Front Vet Sci 2022; 9:915775. [PMID: 36118327 PMCID: PMC9478576 DOI: 10.3389/fvets.2022.915775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/08/2022] [Indexed: 11/30/2022] Open
Abstract
Case 1, a 6-year-old, spayed female Pug, presented with severe systemic urticaria, edema, and erythema. The dog had received a famotidine injection as a treatment for repeated vomiting in another hospital. On physical examination, hyperthermia was observed. Moderate pancytopenia, hypoalbuminemia, and increased CRP and D-dimer were also observed in blood tests. Hyposthenuric proteinuria, pulmonary interstitial infiltration, and hepatomegaly were found in other tests. In the histology of the skin, dermal edema and infiltration of inflammatory cells were observed. Therefore, she was diagnosed with acute systemic hypersensitivity. Case 2, a 13-month-old, neutered male Pembroke welsh corgi, presented with severe and patchy systemic ulcerative skin lesions. The dog had a history of soft feces and pain around the anus 2 days before. Thrombocytopenia, and increased CRP and D-dimer were observed in blood tests. In histology, epidermal necrolysis, separation of the epidermis and dermis, and infiltration of inflammatory cells were observed. Therefore, he was diagnosed with an immune-mediated disease with necrolysis dermatitis. Case 3, a 12-year-old, spayed female Pomeranian, presented with severe systemic alopecia, pustule, and crust on the skin. The dog had received an infection treatment from a local hospital. Severe regenerative anemia (hematocrit 15.3%, negative saline agglutination test, negative slide agglutination test, negative Coomb's test, prominent spherocytes) elevated liver enzymes, and increased CRP and D-dimer were observed in blood tests. On histopathology of the skin, pustules, acantholytic cells, and inflammatory cells were observed in the keratin layer of the epithelium. Therefore, she was diagnosed with Pemphigus foliaceus concurrent with immune-mediated hemolytic anemia. The 3 cases were diagnosed with fatal immune-mediated skin disease concurrently with hematological and systemic abnormalities. All the cases were treated with immune-suppressive drugs, prednisolone, and cyclosporine. In cases 2 and 3, the dogs also received human intravenous immunoglobulin as an immune modulator. The treatment was successful with significant improvements in all the 3 cases.
Collapse
Affiliation(s)
- Soomin Kim
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Chonnam National University, Gwangju, South Korea
- BK21 Project Team, College of Veterinary Medicine, Chonnam National University, Gwangju, South Korea
| | - Yoonji Kim
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Chonnam National University, Gwangju, South Korea
- BK21 Project Team, College of Veterinary Medicine, Chonnam National University, Gwangju, South Korea
| | - Ha-Jung Kim
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Chonnam National University, Gwangju, South Korea
- BK21 Project Team, College of Veterinary Medicine, Chonnam National University, Gwangju, South Korea
| |
Collapse
|
2
|
Spurlock N, Prittie J. Use of Human Intravenous Immunoglobulin in Veterinary Clinical Practice. Vet Clin North Am Small Anim Pract 2021; 50:1371-1383. [PMID: 32896436 DOI: 10.1016/j.cvsm.2020.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Therapy with human intravenous immunoglobulin (hIVIG) as an immunomodulator in veterinary patients results in effective but transient immunosuppression, and may be viable as part of a multidrug strategy against immune-mediated thrombocytopenia and autoimmune cutaneous disease. Efficacy of hIVIG against other veterinary autoimmune diseases is questionable. Veterinary patients tolerate hIVIG therapy well, with few infusion reactions documented. Veterinary clinical trials of hIVIG are limited, and more work is needed to determine the true efficacy and risk of hIVIG administration in companion animals.
Collapse
Affiliation(s)
- Nicole Spurlock
- Animal Specialty Emergency Center, 1535 South Sepulveda, Los Angeles, CA 90025, USA.
| | | |
Collapse
|
3
|
Swales N, Place E, Barnard N, Foster A. Are low doses of oral glucocorticoids as effective as high doses as the sole treatment for canine pemphigus foliaceus? Vet Rec 2020; 185:660-662. [PMID: 31780506 DOI: 10.1136/vr.l6563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Nicola Swales
- Bristol Veterinary School, University of Bristol, Langford, UK
| | - Emma Place
- Bristol Veterinary School, University of Bristol, Langford, UK
| | | | - Aiden Foster
- Bristol Veterinary School, University of Bristol, Langford, UK
| |
Collapse
|
4
|
Prognostic factors and efficacy of human intravenous immunoglobulin G in dogs with idiopathic immune-mediated hemolytic anemia: a retrospective study. ACTA ACUST UNITED AC 2016. [DOI: 10.14405/kjvr.2016.56.3.139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
5
|
Abstract
Treatment of immune-mediated disease in dogs and cats continues to evolve as new therapies are introduced or adapted from human medicine. Glucocorticoids remain the first-line therapy for many of the immune-mediated or inflammatory diseases of cats and dogs. The focus of this article is to provide an update on some of the common immunosuppressive therapies used in small animal veterinary medicine. The goals of therapy are to induce disease remission through the inhibition of inflammation and the modulation of lymphocyte function.
Collapse
Affiliation(s)
- Katrina R Viviano
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI, USA.
| |
Collapse
|
6
|
Sibley TA, Miller MM, Fogle JE. Human intravenous immunoglobulin (hIVIG) inhibits anti-CD32 antibody binding to canine DH82 cells and canine monocytes in vitro. Vet Immunol Immunopathol 2013; 151:229-34. [DOI: 10.1016/j.vetimm.2012.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 10/24/2012] [Accepted: 11/26/2012] [Indexed: 10/27/2022]
|
7
|
Hirschvogel K, Jurina K, Steinberg TA, Matiasek LA, Matiasek K, Beltrán E, Fischer A. Clinical course of acute canine polyradiculoneuritis following treatment with human IV immunoglobulin. J Am Anim Hosp Assoc 2012; 48:299-309. [PMID: 22843822 DOI: 10.5326/jaaha-ms-5651] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Treatment of dogs with acute canine polyradiculoneuritis (ACP) is restricted to physical rehabilitation and supportive care. In humans with Guillain-Barré syndrome, the counterpart of ACP, randomized trials show that IV immunoglobulin (IVIg) speeds recovery. The authors of the current study hypothesized that dogs with ACP would tolerate IVIg well and recover faster than dogs managed with supportive treatment only. Sixteen client-owned dogs with ACP were treated with IVIg, and 14 client-owned dogs served as a retrospective control group. Diagnosis was confirmed using clinical features, electrodiagnostics, cerebrospinal fluid analysis, and muscle/nerve biopsies. The duration of the initial progressive phase, the time from IVIg administration until the dogs were ambulating without assistance, and the duration of the complete episode were evaluated. Adverse reactions (anaphylaxis, mild hematuria) were observed in two dogs. Dogs treated with IVIg were ambulating without assistance after a median of 27.5 days (range, 15-127 days) from onset of clinical signs. The control group was ambulatory without assistance at a median of 75.5 days (range, 5-220 days). Even though this result is not statistically significant, there is a clear trend toward faster recovery in dogs treated with IVIg.
Collapse
Affiliation(s)
- Katrin Hirschvogel
- Clinic of Small Animal Medicine, Ludwig-Maximilians University, Munich, Germany
| | | | | | | | | | | | | |
Collapse
|
8
|
Spurlock NK, Prittie JE. A review of current indications, adverse effects, and administration recommendations for intravenous immunoglobulin. J Vet Emerg Crit Care (San Antonio) 2012; 21:471-83. [PMID: 22316195 DOI: 10.1111/j.1476-4431.2011.00676.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To review and summarize the body of literature regarding human intravenous immunoglobulin (hIVIG) therapy in veterinary medicine. Mechanism of action, usage in human medicine, adverse effects of therapy, implications for veterinary use, and administration recommendations are discussed. DATA SOURCES Current human and veterinary peer-reviewed medical literature including original research articles and scientific reviews. HUMAN DATA SYNTHESIS There are currently 6 labeled uses for hIVIG in human medicine, but preparations are used off-label to successfully treat multiple immune-mediated conditions. To maximize the potential of hIVIG use in animals and identify areas deficient in research, a review of the current literature is warranted. VETERINARY DATA SYNTHESIS Investigation of hIVIG therapy in veterinary patients has been limited to the subjects of immune-mediated hemolytic anemia (IMHA), immune-mediated thrombocytopenia (ITP), Evan's syndrome, cutaneous disease, myasthenia gravis (MG), and sudden acquired retinal degeneration (SARDS). Proponents of veterinary hIVIG use believe administration may reduce transfusion requirements and decrease hospitalization time. CONCLUSION Immunoglobulin (Ig) has not been shown to decrease transfusion requirements in IMHA patients, but shows great promise for treatment of ITP and dermatological diseases. Although serial transfusion of hIVIG is employed in human medicine, repeated transfusion is not recommended in animals due to risk of severe allergic reaction. Other potential adverse effects of transfusion include delayed hypersensitivity reactions, thromboembolism, renal failure, hypotension, and aseptic meningitis.
Collapse
Affiliation(s)
- Nicole K Spurlock
- Department of Emergency and Critical Care, The Animal Medical Center, New York, NY 10065, USA.
| | | |
Collapse
|
9
|
Voie KL, Campbell KL, Lavergne SN. Drug hypersensitivity reactions targeting the skin in dogs and cats. J Vet Intern Med 2012; 26:863-74. [PMID: 22519673 DOI: 10.1111/j.1939-1676.2012.00927.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 01/23/2012] [Accepted: 03/07/2012] [Indexed: 12/22/2022] Open
Abstract
Adverse drug reactions (ADRs) can be dose dependent or idiosyncratic. Most idiosyncratic reactions are believed to be immune-mediated; such drug hypersensitivities and allergies are unpredictable. Cutaneous reactions are the most common presentation of drug allergies. In veterinary medicine it can be difficult to assess the true prevalence of adverse drug reactions, although reports available suggest that they occur quite commonly. There are multiple theories that attempt to explain how drug allergies occur, because the pathogenesis is not yet well understood. These include the (pro)-hapten hypothesis, the Danger Theory, the pi concept, and the viral reactivation theory. Cutaneous drug allergies in veterinary medicine can have a variety of clinical manifestations, ranging from pruritus to often fatal toxic epidermal necrolysis. Diagnosis can be challenging, as the reactions are highly pleomorphic and may be mistaken for other dermatologic diseases. One must rely heavily on history and physical examination to rule out other possibilities. Dechallenge of the drug, histopathology, and other diagnostic tests can help to confirm the diagnosis. New diagnostic tools are beginning to be used, such as antibody or cellular testing, and may be used more in the future. There is much yet to learn about drug allergies, which makes future research vitally important. Treatment of drug allergies involves supportive care, and additional treatments, such as immunosuppressive medications, depend on the manifestation of the disease. Of utmost importance is to avoid the use of the incriminating drug in future treatment of the patient, as subsequent reactions can be worse, and ultimately can prove fatal.
Collapse
Affiliation(s)
- K L Voie
- University of Illinois-Urbana-Champaign, College of Veterinary Medicine, Urbana, IL 61802, USA
| | | | | |
Collapse
|
10
|
Khorzad R, Whelan M, Sisson A, Shelton GD. Myasthenia gravis in dogs with an emphasis on treatment and critical care management. J Vet Emerg Crit Care (San Antonio) 2011; 21:193-208. [PMID: 21631705 DOI: 10.1111/j.1476-4431.2011.00636.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To review the human and veterinary literature on the pathophysiology of myasthenia gravis (MG) and describe treatment options for clinical use in people and animals. DATA SOURCES Human and veterinary clinical reports, studies and reviews, textbooks, and recent research findings in MG from 1996 present, with a focus on treatment and patient management. HUMAN DATA SYNTHESIS MG is a well-described condition in people with new research and treatment options available. Many of the newest therapeutic options available in veterinary medicine for MG are based on current strategies used in people with this condition. Seronegative MG is well described in people and provides insight to clinical cases encountered in veterinary medicine when the index of suspicion is high though serologic tests are negative. VETERINARY DATA SYNTHESIS Previous studies in veterinary medicine focused on the use of acetylcholinesterase inhibitors as the main form of treatment in canine MG. Recent studies, mainly case series and case reports, emphasize the use of immunomodulatory treatments as an alternative for long-term treatment. However, there are no randomized, controlled studies on treatment with immunomodulatory therapy for MG in dogs available to assess the efficacy of this treatment strategy. CONCLUSIONS Although early recognition of clinical signs is most important in the outcome of patients with MG, further understanding the pathophysiology of MG may lead to earlier diagnosis and novel treatment strategies. The discovery of additional autoantibodies against striated muscle proteins in dogs, should enhance our understanding of diseases affecting the neuromuscular junction. In addition, clinical data for canine MG could be applied to other autoimmune disorders.
Collapse
Affiliation(s)
- Roxanna Khorzad
- Department of Emergency and Critical Care, Angell Animal Medical Center, Boston, MA 02130, USA
| | | | | | | |
Collapse
|
11
|
Whitley NT, Day MJ. Immunomodulatory drugs and their application to the management of canine immune-mediated disease. J Small Anim Pract 2011; 52:70-85. [DOI: 10.1111/j.1748-5827.2011.01024.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
12
|
KIM HJ, KANG MH, KIM JW, KIM DY, PARK HM. Long-Term Management of Vaccine-Induced Refractory Ischemic Dermatopathy in a Miniature Pinscher Puppy. J Vet Med Sci 2011; 73:1237-40. [DOI: 10.1292/jvms.10-0524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ha-Jung KIM
- BK21 Basic & Diagnostic Veterinary Specialist Program for Animal Disease and Department of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University
| | - Min-Hee KANG
- BK21 Basic & Diagnostic Veterinary Specialist Program for Animal Disease and Department of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University
| | - Ju-Won KIM
- BK21 Basic & Diagnostic Veterinary Specialist Program for Animal Disease and Department of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University
| | - Dae-Young KIM
- Veterinary Medical Diagnostic Laboratory, College of Veterinary Medicine, University of Missouri
| | - Hee-Myung PARK
- BK21 Basic & Diagnostic Veterinary Specialist Program for Animal Disease and Department of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University
| |
Collapse
|
13
|
Tsuchiya R, Akutsu Y, Ikegami A, Scott M, Neo S, Ishikawa T, Hisasue M, Yamada T. Prothrombotic and Inflammatory Effects of Intravenous Administration of Human Immunoglobulin G in Dogs. J Vet Intern Med 2009; 23:1164-9. [DOI: 10.1111/j.1939-1676.2009.0402.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
14
|
Bianco D, Armstrong P, Washabau R. A Prospective, Randomized, Double-Blinded, Placebo-Controlled Study of Human Intravenous Immunoglobulin for the Acute Management of Presumptive Primary Immune-Mediated Thrombocytopenia in Dogs. J Vet Intern Med 2009; 23:1071-8. [DOI: 10.1111/j.1939-1676.2009.0358.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
|
15
|
Abelson AL, Shelton GD, Whelan MF, Cornejo L, Shaw S, O'Toole TE. Use of mycophenolate mofetil as a rescue agent in the treatment of severe generalized myasthenia gravis in three dogs. J Vet Emerg Crit Care (San Antonio) 2009; 19:369-74. [PMID: 25164637 DOI: 10.1111/j.1476-4431.2009.00433.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the use of IV and oral mycophenolate mofetil (MMF) as adjunctive therapy in 3 dogs with severe generalized myasthenia gravis. CASE SERIES SUMMARY Three dogs suffering from severe generalized myasthenia gravis as confirmed by acetylcholine antibody titers were treated with MMF as part of their treatment regimens. All 3 dogs had radiographic evidence of megaesophagus and suffered from severe regurgitation. Each dog was initially treated with pyridostigmine and supportive agents. When clinical remission was not achieved, IV MMF was administered to all dogs. Signs of clinical remission were apparent within 48 hours and all dogs were later maintained on oral MMF following resolution of regurgitation. NEW OR UNIQUE INFORMATION PROVIDED This is the first report of the use of IV MMF as adjunctive treatment in dogs with severe generalized myasthenia gravis. Outcome was favorable in all 3 dogs and no adverse effects were noted from the MMF.
Collapse
Affiliation(s)
- Amanda L Abelson
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA 01356Department of Pathology, University of California, San Diego, La Jolla, CA 9037Department of Emergency and Critical Care, Angell Animal Medical Center, Boston, MA 02130
| | | | | | | | | | | |
Collapse
|
16
|
Bianco D, Hardy RM. Treatment of Evans’ Syndrome With Human Intravenous Immunoglobulin and Leflunomide in a Diabetic Dog. J Am Anim Hosp Assoc 2009; 45:147-50. [DOI: 10.5326/0450147] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An 11-year-old, spayed female miniature schnauzer with diabetes mellitus was presumptively diagnosed with Evans’ syndrome (ES). Because of the potential adverse effects of immunosuppressive doses of glucocorticoids in a diabetic dog, a single infusion of human intravenous immunoglobulin and oral leflunomide were used as first-line immunomodulatory therapy, after informed owner consent was received. This treatment resulted in complete remission of the ES, and leflunomide was discontinued after 10 months of therapy. Over a 19-month follow-up, the dog did not relapse and has remained a well-regulated diabetic.
Collapse
Affiliation(s)
- Domenico Bianco
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, 1352 Boyd Avenue, St. Paul, Minnesota 55108
- From the
| | - Robert M. Hardy
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, 1352 Boyd Avenue, St. Paul, Minnesota 55108
- From the
| |
Collapse
|
17
|
Whelan MF, O'Toole TE, Chan DL, Rozanski EA, deLaforcade AM, Crawford SL, Cotter SM. Use of human immunoglobulin in addition to glucocorticoids for the initial treatment of dogs with immune-mediated hemolytic anemia. J Vet Emerg Crit Care (San Antonio) 2009; 19:158-64. [DOI: 10.1111/j.1476-4431.2009.00403.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
18
|
Antibody-Mediated Retinopathies in Canine Patients: Mechanism, Diagnosis, and Treatment Modalities. Vet Clin North Am Small Anim Pract 2008; 38:361-87, vii. [DOI: 10.1016/j.cvsm.2007.12.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|