Thrombocytopenia, Corticosteroids Followed By Bipolaris Infection

[Guest WIxiePixie]

Case concerns 8-year-old adopted (off the track) female greyhound. Dog is currently under the treatment of an internist and has received more than $10,000 in medical care. I mention to assure that everything possible is being tried to help this pet. I am looking for comments from anyone else that has experienced anything related to this type of situation.

 

Dog's case started more than 1 year ago with a case of thrombocytopenia. Regular vet used high amounts of steroids to elevate platelet count. About 6 months ago, dog began to break out in sores all over body. The thought was that it was an auto-immune problem, so steroids were increased to the max. (Dog is also on antibiotics, and highest dose of Tramadol.) In January, dog's left front leg began to swell. Dog has difficulty walking. Skin cultures were done. In swollen area, attempts were made to culture fluid (there was none in the joint) and a bone biopsy was done. No signs of osteosarcoma on Xray or from other analysis. Yesterday, the cultures came back (it took a while to grow the fungus) and indicated that the skin infection is caused by bipolaris.

 

She has currently stopped all immune suppressants (prednisone and Atopica) and is now on itraconazole for the fungal infection. Dog is currently at 395,000 platelets per microliter so deemed safe to end thrombocytopenia treatment. We have been able to find little information about this kind of fungal infection in dogs. Prognosis for cure is unknown. I would greatly appreciate comments from 1) anyone whose pet has experienced a fungal infection and/or 2) anyone whose pet has had this type of mystery swelling in the leg. We are hoping to find some information to help this sweet dog, or at the very least create a thread that might be helpful to others in the future. Thank you.

 

 

[macoduck]

Please consider a consultation with Dr Couto. There is a fee ($120?) but well worth it to have him review all lab tests and vet reports. If he can't figure out what's going on he will reach out to other specialists.

http://www.coutovetconsultants.com/for-ownersadopters/

[tbhounds]

It's Couto time. I can comment on the skin lesions however--most likely caused by the pred. With increased corticosteroids comes obviously a reduced immune system--can and often leads to a dermal staph infection.

Dr Couto's new Greyhound Health Initiative is up and running. You can contact him via his Consult site..

 

http://www.coutovetconsultants.com

or become a member of his new program..

 

http://greyhoundhealthinitiative.org

Edited June 6, 2015 by tbhounds

[KF_in_Georgia]

Lucky me: I've been where you were--with 8-year-old ex-racer named Jacey who developed idiopathic immune mediated thrombocytopenia (I lost her after 4 days)--and I've been where you are.

 

Silver (who arrived the day after I lost Jacey--both girls have the same birth date, two years apart, and it seemed as if the universe was sending a message) was picked up as a stray by animal control in a neighboring county. She was skinny, no microchip, apparently not adopted out through regular channels (turns out, she hadn't been spayed), heartworm negative (thank dog). I got the distinct impression that she didn't go even a little feral during her time on the streets, and I wouldn't be surprised if she marched up to the animal control officer on the street and just demanded her dinner. She was six years old, had raced until she was three and a half, but her former track (Victoryland) had closed and we don't know what happened between when she retired and when she showed up on the streets two and a half years later. She arrived with a corn (front right) and with a slipped Achilles tendon (back right), so it seemed likely that one or both of those problems ended her career (she'd been a good racer and had run A-grade for about 9 months). World's softest, thickest coat, with downy white fuzz all the way down her belly; personality to spare. Zero-tolerance for cats.

 

In addition to the problems with her right legs, her front left leg looked like this:

 

 

The animal control vet, the vet of the rescue that examined her first, the vet that treats SEGA's dogs, and my own vet: they all looked at this, did skin scrapings, looked under black light, said "bacterial infection" and prescribed Simplecef and a round of prednisone. In all cases, it briefly looked better, then went back to this. It itched a lot--Silver chewed it madly. She'd relax if I smoothed on some soothing cream, then she'd start chewing again the moment I stopped. I kept her muzzled to stop the chewing. She learned to scratch the front left leg with her back left foot. (Considering that neither foot on her right side could support her normally, the back-left-foot-scratch was something of a challenge.) My vet tried a few other things: ivermectin (in case it was mites), different antibiotics. The rash of raised bumps wasn't contagious: neither I nor my other dog had any problem.

 

I finally did what I wish I'd done in the beginning: I took her to a veterinary dermatologist. He took three punch biopsy samples and immediately put her on Simplecef. Again. (I thought he was blowing smoke with that prescription.) Two weeks later, we got back the biopsy results. Under the bacterial infection on her skin (caused by the constant chewing), Silver had plain ol' ringworm. It was below the skin, which is why it never showed on skin scrapings or under black light, and why it didn't spread to me, the other dog, or even anywhere else on her skin. The dermatologist prescribed oral ketoconazole to go along with the Simplecef.

 

In a week, Silver stopped chewing and scratching. In two weeks, the rash was almost completely gone. I don't remember now how long she stayed on the meds, but the dermatologist wanted her on the ketaconazole extra time to make sure the fungal infection didn't come back, resistant to what we'd used already. The rash went away, her hair grew back, and she had not (as we feared she might) developed a behavioral tic requiring constant licking of that front left leg.

 

This is Silver. She's 10 years old and she's a registered therapy dog. There's no indication that there's ever been anything wrong with her skin.

For your girl, I'm more concerned about the swelling in the leg than the fungal infection. That's probably because Silver kicked her fungal infection to the curb, while I lost Jacey--and one of the last complications she experienced was disseminated intravascular coagulation (DIC) accompanied by swelling in her back legs.

So, after saying all this, I'm going to echo what the others have recommended: Consult with Dr Couto. You may be on your way to controlling the fungal infection, but that swelling worries me a lot.

 

[Guest MotherOfHounds]

Hi WixiePixie, bipolaris infection is pretty rare, so I'm not surprised you haven't found much information. Our four-year-old brindle has a bipolaris infection of the bones of her foot. It took hold in a broken bone and related injuries while she was a stray before we adopted her, but we don't know the exact history of the trauma, so it's hard to know how much was prior trauma and how much is the work of the fungus. She has significant inflammation of the hock and complete deterioration of one toe joint as well as significant deterioration of the bones in that digit. We expect to lose at least that toe in the long run. She's quite functional and motivated more strongly by the joy of zoomies than any discomfort she feels, but her surgeon is afraid of course that she'll snap it and cause further injury.

 

Like you, we're on itraconazole—Sporanox for now, because our internist felt strongly that it provided better uptake and blood levels than the generic equivalent. As you well know, the cost is horrendous, and we'll be considering stepping down to the generic if she makes good strides at healing the external wounds/drains that stem from the underlying infection. We've seen immediate reduction in local swelling, but so far, healing is proving slow and iffy.

 

All signs point to non-disseminated disease for us at this point. In fact, we've seen no bipolaris organisms at all in soft tissue biopsies, bone biopsies, or aspiration from the infected area or an adjacent lymph node. As with your girl, the bipolaris grew in culture. Very frustrating in a way, because it makes it difficult to judge how entrenched it is and how far the infection might have spread. We're not quite sure why the fungus has been able to take hold, since all tests show she is an incredibly healthy greyhound and we don't see any other signs that she is immunocompromised, which of course is the usual situation.

 

I'm glad to hear your girl's other health problems have been resolved, because I know you're facing a challenging road. Have you determined if the infection is localized or disseminated?

 

Feel free to message me privately if you'd prefer.

Edited July 16, 2015 by MotherOfHounds

[Newgreymom]

Just a thought...TBD. I would ask to change antibiotic to Doxycycline. Same thing happened to our Daisy and Doxy saved her life.

[Guest MotherOfHounds]

Just a thought...TBD. I would ask to change antibiotic to Doxycycline. Same thing happened to our Daisy and Doxy saved her life.

 

Your dog was diagnosed with bipolaris and received an antibiotic?

[Newgreymom]

No, I'm sorry she was diagnosed with Thrombocytopenia.

[Guest MotherOfHounds]

Thanks for clarifying. That makes more sense!

[turbotaina]

It's Couto time. I can comment on the skin lesions however--most likely caused by the pred. With increased corticosteroids comes obviously a reduced immune system--can and often leads to a dermal staph infection.

Dr Couto's new Greyhound Health Initiative is up and running. You can contact him via his Consult site..

 

http://www.coutovetconsultants.com

or become a member of his new program..

 

http://greyhoundhealthinitiative.org

 

A friend's greyhound was on pred long term to help manage GME and he would also get the lesions. His skin became very thin, prone to infection and very difficult to heal.

 

OP - if you check back in, update us when you can