Treatment of Severe Adverse Cutaneous Drug Reactions With Human Intravenous Immunoglobulin in Two Dogs

Trotman, Tara K.; Phillips, Heidi S.; Fordyce, Hilary H; King, Lesley G.; Morris, Daniel O.; Giger, Urs

doi:10.5326/0420312

Cited by 30 publications

(35 citation statements)

References 22 publications

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“…This is important because the exact depth of skin necrosis, when shallow, can be difficult to determine clinically, and histologic examination aids disease classification. There are examples in the literature of cases reported to be TEN 1,13,26 that lacked sufficient clinical criteria for TEN and had evidence of dermal necrosis; these were more likely examples of thermal injury or vascular disease in which dermal necrosis can be a feature.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Microscopic Characteristics of Canine Toxic Epidermal Necrolysis

et al. 2014

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Canine toxic epidermal necrosis (TEN), a rare and life-threatening cutaneous drug reaction, traditionally has been described as full-thickness devitalization of the epidermis with minimal dermal inflammation; however, few reports detail the histologic findings. We characterize the clinical features and histologic variations of 3 canine TEN patients. Clinically, irregular erythematous and purpuric macules evolved into widespread and severely painful erosions. The number of eroded mucosae varied; however, periocular and perilabial mucocutaneous junctions frequently were affected. Thirteen of 17 biopsies were evaluated. Apoptosis at multiple epidermal levels was the most common pattern of epidermal necrosis (12/13 biopsies, 92%). In contrast, full-thickness coagulation necrosis was present less often (7/13 biopsies, 52%). Lymphocytic interface dermatitis was the predominant inflammatory pattern, and intraepidermal lymphocytes, along with fewer histiocytes, were present to some degree in all samples along with lymphocytic satellitosis of apoptotic keratinocytes. The sequence of changes points to lymphocyte-mediated keratinocyte apoptosis as an early step in lesion development with subsequent variation in progression to coagulation necrosis among patients. Histopathologic changes overlapped with those reported for erythema multiforme, in contrast to traditional histologic descriptions of canine TEN. A specific algorithm for assessment of drug causality in epidermal necrolysis (ALDEN) was applied for each patient; carprofen was associated with a probable score for causality in 1 dog. Clinicians should be encouraged to take multiple biopsies in TEN suspect cases as nearly 25% of all biopsies lacked epithelium and were not diagnostic.

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Section: Discussionmentioning

confidence: 99%

Clinical and Microscopic Characteristics of Canine Toxic Epidermal Necrolysis

et al. 2014

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“…Toxic epidermal necrolysis is distinguished from a burn by the lack of dermal necrosis. Some cases described in the literature as TEN may be questionable, because significant dermal necrosis was reported . Distinguishing TEN histologically from acute graft‐versus‐host disease can be a major problem in transplantation patients …”

Section: Histological Lesionsmentioning

confidence: 99%

“…Human IVIG is extremely expensive and is rarely employed in animal cases. It has been used successfully in treating a cat with postvaccinal ‘EM’ and two dogs with probable drug reactions . A 2011 review of indications for hIVIG therapy suggested great promise for treatment of animal skin disease .…”

Section: Treatmentmentioning

confidence: 99%

Erythema multiforme, Stevens–Johnson syndrome and toxic epidermal necrolysis: a comparative review

Yager

2014

Veterinary Dermatology

139

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“…Meanwhile, IVIg is effective for refractory systemic and cutaneous vasculitis in humans [1,10]. Recently, hIVIg was reported as effective and safe in the treatment of dogs with adverse cutaneous drug reactions and pemphigus foliaceus, which are severe immune-mediated skin diseases [12,19]. In this case, clinical improvement was not maintained by only IVIg, necessitating the use of other immunosuppressive drugs.…”

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confidence: 81%

Long-Term Management of Vaccine-Induced Refractory Ischemic Dermatopathy in a Miniature Pinscher Puppy

Kim

Kang

Kim

et al. 2011

The Journal of Veterinary Medical Science

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ABSTRACT. A 2-month-old intact female Miniature Pinscher puppy presented with footpad swelling and crusted pustules of ear pinnae. The dog had been vaccinated with a polyvalent canine vaccine 5 days prior to the onset of clinical signs. With the history of recent vaccination, the clinical presentation and the histopathological observations were suggestive of ischemic dermatopathy. Treatment involved oral prednisolone, azathioprine, and other immune modulating drugs, which did not work. Chlorambucil plus cyclosporine therapy was initiated for vigorous immune suppression after rush therapy using intravenous immunoglobulin. Clinical signs again gradually improved with no relapse or side effects, even at a 4-month follow-up. The case report is suggested ischemic dermatopathy refractory to conventional therapy and suggests effective approaches to long-term management of the disease.KEY WORDS: canine, intravenous immunoglobulin, ischemic dermatopathy, vaccine.J. Vet. Med. Sci. 73(9): 1237-1240, 2011 Ischemic dermatopathy is a syndrome that results from loss of blood supply from either vasculitis or vasculopathy [16]. It is often related to dogs with postrabies vaccination associated disease [5]. The lesions of ischemic dermatopathy subsequent to rabies vaccination are characterized by alopecia and focal vasculitis [5]. Meanwhile, reports have described vaccine-induced ischemic dermatopathy associated with not only rabies but also multivalent puppy vaccines [5,20].Management of the disease in veterinary medicine typically includes the use of glucocorticoids, dapsone, pentoxifylline, sulfasalazine and vitamin E with antibiotics [8,9,11]. However, some cases fail to be managed with these treatments and require long-term maintenance therapy [16]. This case report describes a dog with putative vaccineinduced canine ischemic dermatopathy that was refractory to conventional therapy.A 2-month-old, intact, female, Miniature Pinscher puppy presented with acute swelling of the feet and pustular lesions on ear pinnae. The dog had been vaccinated 5 days prior to the onset of clinical signs. The vaccine was a modified live combination product that included distemper, hepatitis, parainfluenza and parvoviruses and killed corona virus. The clinical signs worsened after 2 weeks following a second vaccination with the same vaccine.On physical examination, severe swelling and crusts were present on the foot pads, ruptured pustules were present on ear pinnae and a necrotic ear margin was found (Fig. 1). There were no specific lesions on the site of vaccination. Hematology and serum biochemistry were within normal ranges. Radiographs of the swelled feet were unremarkable. Skin scrapings were negative for ectoparasites. Cytological examination of the pustules on ear pinnae revealed sterile pyogranulomatous inflammation. Differential diagnoses included cutaneous vasculitis (ischemic dermatopathy), juvenile cellulitis, systemic lupus erythematosus, and pemphigus complex, infectious diseases, and histiocytic tumor. There were no proteinuria an...

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Treatment of Severe Adverse Cutaneous Drug Reactions With Human Intravenous Immunoglobulin in Two Dogs

Cited by 30 publications

References 22 publications

Clinical and Microscopic Characteristics of Canine Toxic Epidermal Necrolysis

Clinical and Microscopic Characteristics of Canine Toxic Epidermal Necrolysis

Erythema multiforme, Stevens–Johnson syndrome and toxic epidermal necrolysis: a comparative review

Long-Term Management of Vaccine-Induced Refractory Ischemic Dermatopathy in a Miniature Pinscher Puppy

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