Canine Vasculitis Kim Matthon June 19, 2013

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1 Canine Vasculitis Kim Matthon June 19, 2013 What is Canine Vasculitis? Vasculitis is an inflamation of blood vessels, resulting in a compromise of blood supply to affected areas. The inflamation is caused by an over stimulation of the immune system. The immune system over reacts and begins attacking its own tissue. There are many causes of vasculitis such as infections (bacterial, viral, fungal or tick borne diseases), drug or vaccine reactions, neoplasia and autoimmune diseases. Vasculitis happens when infection or inflammation reaches the endothial cell layer. For example: Bacteria, viruses, toxins, parasites or by products of the immune system can accumulate in the endothial layer and can lead to a inflamatory response in multiple sites of the body. In many cases an uderlying cause can not be determined. Vasculitis is not very common in canines and rare in felines, however it can affect any breed, age or gender. Other underlying causes for systemic vasculitis include: Drug interactoin Neoplasia abnormal tissue growth, tumor Kidney disease Allergies to food or drugs Joint disease, such as rheumatoid arthritis Types of Vascultis There are many different types of diseases that belong to this category. Although the diseases are similar in some ways, they often differ with respect to inciting cause, which organs are affected and which medications are used to treat them. Clinical Signs and Symptoms for Canine Vascultis Symptoms may vary depending on which organs are involved such as the liver, kidneys,skin or brain. In vascultis caused by a vaccine, there is localized hair loss at the site where the vaccine was administered which can occur 1-3 months after the vaccine was given. Some canines with vasculitis can show other systems such as: Skin ulcers, especially in areas such as the ear pinnae, lips, mouth, paws, tail and scrotum. Bruising Patches of dead skin, including on the footpads Bleeding Page 1

2 Swelling Lethargy Fever Pain Decreased appetite and weight loss Inflammation of the interior of the eyes Joint inflamtion and swelling of the extremities Vasculitis Diagnosis The veterinarian will begin with the standard diagnostic analysis, including complete blood count, biochemistry profile, electrolytes, and urinalysis. Any abnormalities that show up in the results of the lab tests will depend on the underlying disease or disorder. Your veterinarian may need to conduct various tests to conclusively diagnose the primary disease responsible for the symptoms such as X-rays and ultra sound. Gold standard for diagnosis is a skin biopsy. If food or drug reaction is suspected, the first recommendation is usually to discontinue the use of the suspected food or drug and to judge the response. If this is the case, your veterinarian will advise on the appropriate diet. It is not advisable to make dramatic diet changes without the guidance of a health professional. Treatment of Vasculitis in Canines The primary goal of therapy is to treat the underlying condition responsible for the inflammation of the blood vessels, if it can be identified. In cases of underlying immune-mediated disorder, your veterinarian will prescribe medications to suppress blood vessel inflamation. Medication that may be effective include. Steriods (Prednisone) Pentoxifylline A combination of Tetracycline and Niacinamide Dapsone Sulfasalazine Cyclosporin Azathioprine In some cases more than one medication may be required to control the symptoms. Some dogs will require life long medication for control, however others may be able to be weaned off of medication. Relapses are possible. Prognosis for Vasculitis The prognosis depends on a variety of factors and the underlying cause (if diagnosed), the severity of symptoms and the extent of the organ involvment. Page 2

3 Vascultis Maintenance and Prevention You will need to revisit your veterinarian at regular intervals for an evaluation of your dog's response to treatment and so that adjustments can be made as needed. Your veterinarian will probably need to run regular blood tests, especially early on in treatment to ensure there are no side effects from the medication. It is also critical to administer all of the prescribed drugs, at their prescribed doses and times, for the entirety of the time your doctor has recommended. As these drugs suppress the immune system, you will need to monitor the dog closely for any irregularities, change in health status, or new instances of illness. These types of drugs have the potential for serious side-effects, since the body is more vulnerable to infections as a result of the immune suppression. You will need to do as much as possible to protect your dog from any new infections, and provide for him a healthy diet and a stress-free living environment. Massage Therapy Benifits for Pets with Vasculitis Massage is known to decrease inflamation and increase blood circulation. As vasculitis is an inflamation of blood vessels and in many cases involves the immune system any treatment that decreases inflamation and or promotes a healthy immune system, could be bennificial in prevention or lessening the effects of this disease. Massage is also beneficial for dogs that have vascultis that are on life time medications such a Prednisone as it will help with muscle tone as one of Prednisone's side effect is weight gain. When a dog is having symptoms of vascultis it is not recommended to preform massage as the dog will be very painful. Massage should be used as prevention therapy only. Case Studies These cases were all diagnosed and treated at Birchmount Veterinary Clinic Birchmount Road. Scarborough Ontario, Canada. Case Study 1 - Dr. Robert Pepper Jones DVM Name: Harmony Kesha Breed: Chihuahua Sex: Spayed female Age at diagnosis: 6 months / 2010 Presenting Complaint - Painful, lumps all over her body, crying and lethargic. Clinical Signs - Skin lesions, crying in pain when touched. Exam Findings - Skin lesions not healing, lumps all over body, very painful to touch. Was vaccinated and spayed with in the last 3 weeks. Diagnostics - Cytology - Normal, Bloodwork- Normal, Skin Culture aerobic and anerobic - Normal. Skin Biopsies - Findings were severe necrotizing and suppurative dermatitis with superficial cutaneous infarction and occasional small vessel vasculitis. Main concern based on the histologic lesions was septic vasculitis, more likely an immunologic vasculitis. Treatment - Clavamox, Hydromorphone, Prednisone, Pentoxifylline & Dermagel to help heal the wounds. Page 3

4 Monotoring - Monitor for lumps and skin sores. No vaccines. Bloodwork at least once a year and yearly examinations. Course of Diesese - In 2013 Harmony Kesha is 3 years old and is doing well. She continues to take Prednisone and Pentoxifylline and will have to for life. Harmony does not recieve vaccinations there for her immunity is low which restricts her from interacting with other dogs. Pictures of Harmony Kesha in hospital. Case Study 2 - Dr. Lisa Radchenko DVM Name: Onyx Sex: Spayed femal Breed: Sharpei Mix Age at diagnosis: 5 years old / 2010 Presenting Complaint - Lethargy Clinical Signs - Panting, decreased appetite, stiffness Exam Findings - Fever, discharge and matting of the hair. Once the areas were shaved there was Page 4

5 ulcerations and skin necrosis. Swollen joints. Diagnostics - Blood work - Normal, Urine - Normal Skin biopsies showed - Neutrophilic superficial dermal vasculitis. Treatment - Pentoxifylline, Doxycycline. Monotoring - Cautious with vaccines, split vacinations. Watched for reactions, owner monitored closely for skin lesions, as this will be a lifetime concern for Onyx. Course of Diesese - In 2013 Onyx is now 6 years old. Onyx is doing fine and has made a full recovery. The owners still have to watch for skin lesions, split up vaccines and have annual check ups done. Onyx is not on any medications for Vascultis at this time. However Onyx is on a special diet for her skin. Case Study 3 Dr. H.H Barrett DVM Name: Sebastian Breed: Jack Russel Terrier Sex: Neutered Male Age at Diagnosis: 6 moths old / 2012 Presenting Complaint - Sores on head and ear tips. Clinical Signs - Skin lesions not healing, itchy. Exam Findings - Scabby lesions on ear tips and a larger one on the head. Very itchy. Diagnostics - Skin scraping - Negative. Blood work - Negative. Skin biopsy - Cell poor interface dermatitis with follicular atrophy and "busy" dermis. Lesions typical of Ischemic Dermatopathy (Jack Russell Vasculitis) Treatment - Pentoxifylline, Predisone. Monotoring - Monitor for lesions, continue Prenisone and Pentoxifylline. Yearly blood work, and examinations. No Vaccinations. Course of Diesese - In 2013 Sebastion is now18 months now and once in a while he gets scabby skin and loses hair but is doing very well. Sebastian eats a vegan formula diet and the owners have to watch his food intake closely as he can not tolerate any animal protiens. He is also on Prednisone and Pentoxifylline and will continue this medication for life. Pictures Of Sebatians skin lesions. References: Page 5

6 Birchmount Vet Clinic Birchmount Road, Scarborough Ontario Canada. Dr. Robert Pepper Jones DVM. Dr. H.H Barrett. Dr. Lisa Radchenko. February Veterinarian Info Network (VIN) Page 6