Thursday, September 1, 2011

The emaciated Shih Tzu has pemphigus vulgaris? Reviewed 4 days later

Thursday, Sep 1, 2011

"My dog looks forward to coming to your Surgery," the daughter said to me. "She used to be afraid of going to the vet." I was surprised to see this 10-year-old Shih Tzu so much more energetic and wagging his tail, as if she wanted to enjoy every second of living.

4 days of medication and better food like meat and eggs and she looked so full of energy. I had scheduled the operation at 10 am but since the owners had problems getting a taxi on the road side, the dog's body felt very hot. I had to postpone the surgery to next Monday as it is not wise to operate a dog that is hyper-excited. This is an old dog with poor nutrition as Vet 1 had advised to feed only vegetables and rice as the dog suffered from skin diseases, including big ulcerations in both ears and below the pads of all paws. The owner said that the original skin problem started with the ears. Vet 1 had diagnosed an auto-immune skin condition called pemphigus* and so advised vegetables and rice only.

"We had been waiting for the taxi for one hour and under the sun," the daughter said. "Next time, I will book a taxi."

This could be a case of pemphigus vulgaris and pemphigus foliaceus. The owners complained that the dog had blisters or ulcers in the ears first (I took some pictures - pemphigus foliaceus starts as blisters in the ears and spreads to the body but does not involve the mouth).

In this case, the mouth got ulcers esp. at the skin-mouth junction. Pemphigus vulgaris involves the muco-cutaneous junctions but not pemphigus foliaceus). Now the dog also has "ulcers" in both ears, ulcers in the mouth-skin junctions and all the pads of the 4 limbs. I have images to show later.

The prednisolone injection given did suppress the auto-immune system. The submandibular lymph nodes are now not spreading caudally like a long cord involving the other lymph nodes, as at 4 days ago. The swelling is now localised at the submandibular lymph nodes which are around 3 cm x 3 cm x 2 cm - very large.

I took a blood test and would review the case 3 days later again. Biopsies for histopathology would need to be specially prepared to get good lab results and these may be costly.

In conclusion, this could be a case of pemphigus vulgaris and pemphigus foliaceus. Long-term immunosuppressive treatment and regular monitoring would be the treatment. Over-treatment will kill the dog and so there must be a long-term care and blood test for this dog.

*REFERENCE
Pemphigus and Pemphigoid in Domestic Animals:
An Overview - Can Vet J 1985; 26: 185-189.
LOW ELL J. AC K ERMAN
Denison Veterinary Services,
1151 Denison Street, Suite 2,
Markham, Ontario L3R 3 Y4
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1680036/pdf/canvetj00606-0015.pdf

In pemphigus foliaceus and vulgaris, diagnosis is based on history, clinical signs, histopathology and immunopathology. Therapy must be immunosuppressive to be effective and is palliative rather than curative.

In practice, it costs a lot of money to diagnose this skin disease. The owner had spent quite a large sum of $2,000 previously. In this case, rather than making the owner to spend more money on biopsy, I consider that it is best to get onto the immunosuppressive treatment and regular 3-monthly monitoring of blood to ensure that the dog is not killed by over-treatment of the immuno-suppressive drugs.

That would be in the best interest of the owner and the dog. I will review in 4 days' time, ie. on Monday. The dog is much well loved as a family member especially the daughter. Pemphigus is a rare skin disease in dogs and so is sometimes diagnosed as allergies to dry dog food - hence Vet 1's recommendation of home-cooked vegetables and rice.

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