Hello, looking for help and advice.

[Pam]

Hi, my name is Pam and I came across this website when researching auto-immune diseases in dogs. One of my dogs Fizz a ten year old lab who has after 2 years of skin problems tested positive for discoid lupus but the vets think she might have systemic lupus as her symptoms arent typical.
Briefly she started with dry, cracked nose and loss of pigmentation I researched on the net and thought it looked like discoid lupus, vet agreed and booked her in for a biopsy. unfotunately vets did biopsy of a cyst on her leg I had asked about and not her nose (miscommunication between the 2 vets). She gets so traumatised going to vets and I didnt want another anaesthetic so never got a definate diagnosis at this point.
Used sun protection and supplements and nose has improved but she got patches on her body of dry flaky skin where hair grew back white (she is a black lab). 2 weeks ago she started with nosebleeds and they have happened every other day only small amount of blood for a couple of minutes.
She has had normal x-ray of nose/skull normal blood and urine test and normal nose swabs but tested positive for discoid lupus from skin biopsy.
Vets want to put her on steroids as they think the bleeding could  be due to systemic lupus. I am at a loss what to do, she is so well in herself worried side effects of steroids will affect this but I am worried about the bleeding. Can this be due to discoid lupus and are steroids the only option? She has just had a course of anti-biotics.
Any advice would be most welcome.

[Jo CIMDA]

Hi Pam and Welcome

I'm sorry you are having these problems with Fizz.  If Fizz had had SLE (systemic lupus erythematosus) for the last two years many more body systems would have been involved and she wouldn't appear so well.  Now that you have had a definitive diagnosis of DLE you know the reason for her crusty nose and this may also be the reason for her hair growing back white which is called vitiligo.  As both DLE and vitiligo are autoimmune diseases, this means Fizz has a genetic predisposition to autoimmunity.  Some dogs will only get one autoimmune disease but others will get two or more and there is no way of knowing how many a dog will get or which diseases they are predisposed to.

Have the vets done a recent full haematology and a full biochemistry blood test?   Is Fizz bleeding from one nostril or both nostrils?  If Fizz has an autoimmune problem with her blood platelets, which is causing bleeding, then the nose bleeds will come from both nostrils if, for example, she has a polyps up her nose then it is likely only to come down the nostril that is directly affected. 

Autoimmune destruction of the blood platelets is called immune mediated (or autoimmune) thrombocytopenia (IMTP).  For a dog to spontaneously bleed the platelets have to be less than 40-50 (reference range somewhere between 150 -400).  Does Fizz have any bruising or is she passing black stools?  These are indicators of IMTP.  There is an article in the files that may help.

If Fizz has IMTP then she must have steroids and in immunosuppressive doses. Again, in the files you will see an excellent drug protocol by Prof. M J Day. There is no other way Pam, and if given in time (before the platelets become dangerously low) IMTP usually responds to steroids within 5 days.  You must find out exactly what is causing the bleeding before you can start treatment. If the correct dose of steroids is given and for the correct duration then the side effects will be managed.

If she has SLE then it wouldn't just be her nose and platelets that are affected, but it is possible that she has DLE and IMTP.  Steroids will address both problems.

If it is IMTP then don't delay because the sooner you treat the sooner her platelets will increase and she will get better.  There are lots of people here who have had to deal with this, so you are not alone.

Good luck
Jo

[Pam]

Thanks for your reply and the info. Fizz has had a bio-chemical profile done which was normal and she is going to have a full blood count tomorrow, she is bleeding from one nostril. The x-rays of her skull and nose were clear they were checking for nasal tumours and aspergilliosis, know that still possible it could be a tumour but vet thinks unlikely.

Spoke to the vet today and agreed if fbc shows low platelets then will have to start steroids.  Her stools are normal colour and no sign of bruising, gums are nice pink colour. Even if levels normal vet thinks small dose of steroids might help with bleeding. I have had very negative experience with steroids in the past with dog who had cushings and one who had lymphoma but after reading information on here see it is the way to go if she has IMTP.

I did wonder if the DLE could have caused some damage/erosion further inside her nose or ulceration or damaged a blood vessel that is causing the bleeding? It is almost like a small build up of blood that comes away, there is about 2 teaspoons full it lasts a couple of minutes then stops. She does sneeze a bit and shake her head but has been doing it since she started with the DLE.

I also forgot to mention she is on a small dose of loxicom for stiffness which will have to stop if she starts steroids but vet thinks stiffness will be controlled on steroids.

If the fbc is normal vets are talking about rhinoscopy and cat scan but I want to try and keep investigations to a minimum at the moment, she is still traumatised from last visit. As well as skull/nose X-ray they did abdominal x-ray and needle aspiration because abdomen looked distended (does look like this due to previous ops) and skin is sore where stitches are from biopsy. She does get incredibly stressed just going to the vets. Worried stress will make her condition worse.

The information on here has been really helpful, 5 different vets at our practice have seen her and been at a loss,
all commented never seen the white hair growth before.

Thanks again and should know bit more after next blood test. Pam

[Jo CIMDA]

Hi Pam

I have never known a bleed due to a primary DLE.  I would think it unlikely, but she doesn't have any other signs of IMTP and if the nose bleeds were due to low platelets then bruising and blackened faeces would be expected.  It could still be aspergillosis or a tumour. I presume she doesn't have a purulent discharge.  Personally, I wouldn't give her steroids unless IMTP has been definitively diagnosed because to treat IMTP the dose of steroids has to be high (immunosuppressive), also if she is to have an rhinoscopy and biopsies then the steroids could interfere/mask the results. If her stiches are sore perhaps she needs different antibiotics.

Good luck tomorrow.  I'm glad you found the information helpful. 

Jo

[Pam]

The fbc came back normal for Fizz and test for aspergilliosis was negative the vets dont think it is a tumour because they have looked up her nose and x-ray is clear and she has no other symptoms so still dont know what causes the nosebleeds but they have decreased so just going to monitor how she is over the weekend.

I spoke to a different vet today and she wondered if the lesions she has had on her body may be inside the nose.
The ones on her body are the size of 50p and are now white, she has about 10, they are all healed and have never caused any itchiness or discomfort. So this might be a possibility.

She has been precribed a steroid ointment trimovate for her nose which is a for people , vet said they no longer license animal one.

Think it is a case of waiting and see how she goes now, keeping fingers crossed nosebleeds subside.

Thanks again Pam

[Jo CIMDA]

My fingers are corssed for Fizz too Pam.  Wait and see. If the bleeds continue you may have to repeat the rhynoscopy and biopsies.  I hope the Trimovate helps.

Jo

[gschellinger]

Hi Pam,
I'm just coming in on this thread. If you see more nose bleeds an MRI would be the best in diagnosing a lesion. Lola has had nasal discharge since Nov. and I have talked with many vets concerning her problem. She cannot be safely sedated because of a brain condition, so we don't know why she is having this discharge. I joined the cancer group on Yahoo and several of them had dogs with nasal cancer. All have nose bleeds. Lola does not so we have ruled it out mostly.

The vets have explained the nasal structure and the biopsy procedures to us. Because of all the delicate bones in there, the turbinates, biopsy is very difficult, as the problem could be inside these bones, or in the sinus of the head, and the way they describe it, it causes a lot of bleeding. It is mostly a blind kind of procedure which doesn't necessarily get to the place where the problem may be. An MRI can detect the place of interest though, so that they can more accuratly find it. My dog also tested neg. for fungal as well as bacterial. So we are still in the dark about what is causing her problems.

I'm hoping you don't need to think about this anymore and your dog returns to normal. I would tend to think like you are, that it could be from the lupus.
gail