Dog had autoimmune sialodenitis before SRMA?

[susannaheinze]

What a mystery I have been dealing with!

Here we go -- and I'm REALLY hoping to get a response from the all-famous Jo! :-)
December 2017 -- long road trip with CAR-PHOBIC Australian Shepherd (1.75 years at the time). 
2 days after returning home he wouldn't eat, wouldn't drink, held head painfully.  A mass could be palpated under his jaw. 
Vet aspirated 20 cc's off, suspected sialocele (salivary mucocele -- it's like a cyst that pools saliva if the duct is blocked).  Sent fluid to pathology.  Pathology reported that there were "moderate" numbers of nucleated cells, comprised mostly of lysed macrophages and neutrophils, with very few small lymphocytes and plasmacytes.  No organisms seen.
Next day, I had to take my dog back to the vet.  His symptoms were not improved + the spot had become bigger and harder!!!  Vet prescribed tramadol and vetprofen to manage the inflammation.
Fast forward  - May - the mucocele returns.  I took dog to specialty vet for surgery consult.  Estimate was $5500. We were waiting for an appointment in Canada for a second opinion (hopefully cheaper!!). 
June 2018 - another long-roadtrip with CAR-PHOBIC dog! :-( 2 days after return, meningitis strikes!!!  We had a working diagnosis (no MRI, no lumbar puncture) with the Seattle specialty vets within 48 hours.  Steroids alleviated clinical symptoms within 8 hours. 
Now home for 1 week.  On prednisone and abx (since no definitive diagnosis of SRMA could be made without lumbar puncture).  "mucocele" is completely gone.  After much research, I did find an case study about a dog with autoimmune sialodenitis.  And everything just CLICKED.  It explains why his "mucocele" was so painful.  It explains why the roadtrips triggered the (autoimmune) cases.  It explains why his cytology for his "mucoceles" included so many WBCs, and even specifically T and B cells.
My dog is just plain auto-immuney.......

[Jo CIMDA]

Hi and welcome

I hope you didn't mean infamous Jo!

Gosh what a time you have had, but I really think you have cracked it.   I do hope your boy is being treated with the correct amount of prednisolone.

A definitive diagnosis is not always possible, and also not always necessary if the vet you are seeing has experience.  Clearly this specialist knows his stuff! The diagnostic criteria for most of the common AI diseases is clearly defined but  believe me there are lots of variables and of course one, two or more AI disease can develop at the same time.   It could be that the SRMA might have been grumbling under the surface whilst the salivary mucocele developed or the salivary mucocele  might even have triggered the SRMA.  The good news is with the quick and positive response of immunosuppressive treatment a definitive diagnosis is not necessary and you can realistically assume that both conditions are AI related.   Clever you for linking the two.

A salivary mucocele is very rare but  AI disease can develop in any part of the body.   I once had a young boy who started with masticatory myositis  but his whole body developed oedema to the extent that he blew up with so much fluid he could hardly walk.  In the end almost all his body systems were affected.   So nothing surprises me anymore.

I am sure your boy is feeling so much better now he is on immunosuppressive doses of steroids.  Please check the protocol he is on against the one below:

Example: Reduction Protocol for prednisolone:

Clinical Immunology of the Dog & Cat , 2nd Edition,  by Michael J Day
Professor Michael DayBSc, BVMS(Hons), PhD, DSc, DiplECVP, FASM, FRCPath, FRCVS 

Professor of Veterinary Pathology, University of Bristol, UK and WSAVA - Chairman of Scientific Advisory Committee.

This example is based on a dog receiving an induction dose of 1.0mg/kg/q 12hrs (q = every)
Dose                           Duration (based on clinical effect)
1.0mg/kg/q 12h                          10-28 days
0.75mg/kg/q 12h                       10-28 days
0.5mg/kg/q 12h                         10-28 days
0.25mg/kg/q 12h                        10-28 days
0.25mg/kg/q 24h                        10-28 days
0.25-0.5mg/kg EOD                    at least 21 days
0.25-0.5 mg/kg every third day      at least 21 days

Every reduction is made after consideration to improvement of clinical signs, blood results and side effects of the drugs.

Prednisolone: "Doses above 2.2mg/kg/day do not give more immunosuppression but do cause more side effects. Many internists believe that prednisolone doses should not exceed 80mg per day, regardless of the dog's weight."  Plumb's Veterinary Drug Handbook Eight Edition.


Prof Day is among the world's top veterinary immunologists and this is the best protocol I have come across and it can be confidently used as a guide.

SRMA has an excellent prognosis but relapses do occur especially in the early months when tapering the steroids.  Following a good protocol gives you the best possible chance of achieving remission and also limiting the side effects of the drugs.   

I don't know how you can limit the 'trigger' car journeys,  but trigger factors have to be reduced as much as possible.  Often AI disease such as SRMA and IM polyarthritis occur more in young dogs, and although they may relapse it very often seems to settle down and many never get it as an older dog. 

Make sure he is receiving a gastroprotectant to protect his stomach from the excess acid that the preds produce.  Ranitidine or Omeprazole are the most commonly used gastroprotectants.

Jo