Seeking Advice - Immune Mediated Disease

[Guest Gingermadison]

Our male 5yo GH was diagnosed 2 years ago with pemphigis. Since that time he has been on a series of steroids, immunosuppressants, and other supportive drug therapies with mediocre results. Twice last January (2017) and again this week (January 2018) he developed visible swelling in his rear hock. The vet treated is as a possible infection last year, suspecting secondary infection from a persistently swolen toe. Tests of the ankle fluids came back negative for infection. Nonetheless, we kept him on antibiotics for eight weeks (this followed several shorter rounds of antibiotics prescribed for the toe). Ulimately we had that offending toe amputated (when it inflated despite being on antibiotics). Aside from signs of pemphigis deep in the toe tissue, the cytology was unremarkable. Now the same hock is again very inflamed. I now suspect a secondary auto-immune process (IMPA?) may be involving his joints in addition to the Pemphigis. We discovered after we adopted him in 2014 that he had a positive Babesia titer several months prior. Wondering whether anyone has experience with pemphigis and IMPA, and whether there is a correlation with either to babesia infection. Thank you for any information or suggestions on additional tests or treatments we should consider.

[greysmom]

I don't have any experience with either disease, but just from my limited googling ( ) it doesn't seem that pemphigus is even applicable from what you described. The primary symptom appears to be skin lesions, pustules and cysts on the surface of the dermis, so I'm unclear as to how this was diagnosed.

 

IMPA however, does seem more likely, as it involves joint swelling and lameness associated with that. It also *can* have a bacterial or viral cause, and babesia would seem to fit with that better than pemphigus.

 

Autoimmune diseases are just so hard to deal with - I know because my husband has one! - so I feel your pain and frustration. My thought would be that if you are not seeing a specialist, that it is time to look one up and see what they say. And, while it's not his area of expertise, you can also contact Dr Guillermo Couto, a veterinarian with probably the most experience with greyhounds and their diseases. It might be worth sending him your dog's records and ask him to review them. Here's a link for consults with him:

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

[Riverhound]

The threads are really old, but there was a dog named Robin on GT who had pemphigus with similar symptoms. Cute cowdoggie, IIRC. OP, you’ve probably already searched GT for pemphigus and found those threads, but if you haven’t, do.

[Guest Gingermadison]

Thanks, greysmom, for your reply. I excluded all the classic pemphigis symptoms -he has plenty of those as well. Thanks for the reference to Ohio State.

[Guest Gingermadison]

Thanks, river hound, for the reply. I looked through Robin’s story. Septic joint was the likely dx last year. If that is the issue, then clavamox has been effective so far. He is on it once again, for now. Would really like to get a definitive diagnosis, though. Thinking we may need to go in for another joint tap and look for both infection and autoimmune this time.

[seeh2o]

My friend has a greyhound with pemphigis, she has been able to keep him off the strong meds with the help of our homeopathic vet. It's still processing, but not rapidly. Here is what she said:

 

"We do: niacinamide (500 mg, 3 times a day), fish oil (once per day), vitamin B complex (200 mg), vitamin c (1000 mg), vitamin e (400 mg), and phosphorous (normal homeopathy dose - 4ish of the larger pellets).

 

We also feed both of them cottage cheese with each meal, and one sardine at dinner.

 

Who knows what in that mess helps, but it is not steroids or antibiotics! Oh, and K9 immunity and turkey tail (1 tsp per day)! Good luck to your friend (on Greytalk)- it is a maddening thing to manage!"

 

I will add my .02¢ to this about the last two supplements. For what it's worth, I switched Bowie from K9 Immunity Plus to 4Life's Transfactor K9 Complete, I couldn't get a real bead on what was in the K9 Immunity Plus and it really bothered me. I have a lot better idea of ingredients with this one and it has at least most of what is in the other. As for the turkey tail, I used the powder until I realized there is a lot of rice powder in it. The mushroom is grown in rice, hence the rice base. I switched Bowie to Metagenics Mycotaki, which is all fruit of the mushroom, no rice. The 4Life is cheaper than the K9, but the Mycotaki is more $ than the turkey tail powder. I found a place in Long Beach that sells the Mycotaki, it's the cheapest I've found, beats Amazon's price. I'd rather pay a mom and pop place than Jeff Bezos!

 

I hope this may help your boy.

[NeylasMom]

What was the Babesia titer? And assuming you never treated for it? Blood work values are all good?

[Guest Gingermadison]

I recall that the titer value was considered borderline when he came off the track and I do not know whether he was tested a second time (he was rehomed two other times before he came to us). His blood values are generally good, aside from low values on his immune system, due to the azo. We have recently added thyro-tabs as his thyroid values were < 1. At last recheck thyroid is in the normal range. He does not show any signs of babesia infection, but I have read that tick bites can trigger AI responses.

[NeylasMom]

Tough. I agree with the rec to work with a specialist at this point. It would be easy enough if the Babesia treatment wasn't a big deal, but its the one TBD that can have more treatment side effects so a more difficult call. Keep us posted please. I hope you can get it sorted out.

 

ETA - I can't remember, is there a better test for Babesia these days? A PCR most likely? If so, it might be worth doing that. I'm so rusty on the TBDs, but I believe NC state has the best options for reliable TBD testing. People used to use Protatek as well, but I don't know that they were offering much more than titer testing.

 

Here you go, click on the download in the first section for the form and more detailed info:

https://cvm.ncsu.edu/research/labs/clinical-sciences/vector-borne-disease/

 

You'd have to discuss with your vet, but maybe the PCR + IFA would give you the best info?

Edited January 21, 2018 by NeylasMom