IMPA in Doberman

[betsytesta]

Hi everyone.  I'm new to the group.  I have a 7 year old Doberman who recently was diagnosed with IMPA.  It started with a lump in her neck back on February 10th, and the pathologist said that it indicated inflammation in her body.  It then moved on to lameness and lethargy.  She was on doxycycline and and rimadyl and had a reaction to one of them and was taken off all meds.  Her liver became enlarged as a result.  My vet was unable to diagnose her, so she spent 3 days in the hospital being stabilized; she had an ultrasound, joint taps, x-rays... and the final diagnosis was IMPA.  We brought her home on March 2nd.  She is on 50mg of prednisone a day and gabapentin for pain.  We have her follow up appointment on the 22nd, but in the meantime, she has developed these ugly blister-like sores on her nose and ears.  She wasn't diagnosed with Lupus, but these sores certainly look like it.  I was told that it didn't warrant a visit to the ER, and it's probably a reaction to the medication and to wait for her appointment.  That's 6 days away, and I would like to make Ahnka comfortable at the very least.  My vet gave me some ointment to help with the itching, as we don't want an infection, but they look worse as the days go by.  Has anyone else had this experience??  Thanks, Betsy.

[Jo CIMDA]

Hi Betsy and welcome

I am sorry Ahnka has IMPA.  How has she responded to the prednisolone, as far as her IMPA is concerned?   

An allergic reaction whilst on an immunosuppressive dose of  prednisolone doesn't seem possible if you consider that prednisolone suppresses the immune system and it is an overactive immune system that results in an allergic reaction.

It could be secondary infection because her immune system is significantly suppressed, and sores can develop,  or it might be part of the multi-systemic disease, SLE (Systemic lupus erythematosus), and the disease process may have started but hadn't fully developed into sores before treatment began. 

Skin sores can occur when a dog is on high doses of prednisolone but this usually occurs after a period of time because the steroids cause thin skin and the dog's immune system isn't strong enough to fight infection.  A course of antibiotics might be needed. Also a dog on prednisolone and with skin sores can  be open to fungal, yeast and parasitic infections too.

I don't know how much a female Doberman weighs. Is 50mg of prednisolone  equal to 1mg/kg/12hrs?  If it isn't then the dose may need to be raised to 1mg/kg/12hrs because this is the lowest immunosuppressive dose for the treatment of AI disease. If it is lower than this, it is likely not be insufficient to bring the IMPA into remission.  If the dose is much higher than this there is a good chance, especially in a large dog, that significant side effects will occur. Take a look at the excellent immunosuppressive protocol below.  It is the best protocol I have come across and it can be confidently used as a guide.  Prof Day is among the top immunologists in the world.

Immunosuppressive Protocols for Oral Prednisolone in the Dog.
Ref: Clinical Immunology of the Dog & Cat by Michael J Day  – Professor of Veterinary Pathology, University of Bristol, UK and WSAVA - Chairman of Scientific Advisory Committee.

Professor Michael DayBSc, BVMS(Hons), PhD, DSc, DiplECVP, FASM, FRCPath, FRCVS 

This example is base on a dog receiving an induction dose of 1.0mg/kg/q12hrs

Dose                Duration (based on clinical effect)

1.0mg/kg/q12h             10-28 days
0.75mg/kg/q12h            10-28 days
0.5mg/kg/q12h             10-28 days
0.25mg/kg/q12h          10-28 days
0.25mg/kg/q24h          10-28 days
0.25-0.5mg/kg/ Every other day      at least 21 days
0.25-0.5 mg/kg/ Every third day       at least 21 days

It might be prudent to start Ahnka on essential fatty acid supplements (Evening Primrose oil, Fish oil and Natural Vit E.)  These are anti-inflammatory and immunomodulatory supplements and are commonly used in therapeutic doses for the treatment of skin disease and allergic skin reactions.

I hope you can sort out this problem very soon.

Jo

[betsytesta]

Thank you, Jo!!  We ended up at the ER again on Friday.  They said it was a secondary bacterial infection; suspected Eosinophilic Furunculosis.  She is on Cephalexin for 14 days.  The lesions look much better two days later, but now I'm seeing swelling in her back feet.  The poor girl can't catch a break...  She is doing better overall, as far as the IMPA is concerned.  She has more energy and is not quite so weak in her back end.  Ahnka is small for a Dobe; she weighs 57lbs when she's healthy.  She's down to 52 now.  My vet says the 50mg (25mg 12h) is a high dose; I'm not sure of the conversion to kg.  Thanks for the info on supplements, etc.   We have our follow up appointment on Wednesday.  Hopefully we'll have more answers then.

[Jo CIMDA]

Hi

57lb is  just under 26 kg, so Ahnka is on the correct dose of prednisolone.  I am so pleased you have her on antibiotics.  Bacterial skin problems are pretty common when a dog is on immunosuppressive doses of steroids.

I hope all goes well on Wednesday.

Jo

[betsytesta]

Ahnka had her second follow up appointment this past Thursday.  They dropped her prednisone dose to 25mg (half) at her last follow up, but this time they said the AMP liver enzyme was elevated.  So no change in the pred dose and we'll see how it is at her next follow up in a month.  Her lesions have cleared up, and she is happy, bright and alert.  She has accidents now and then, but nothing like when she was on the higher dose.  She still hasn't put back any weight, and there is loss of muscle mass especially on her head and flanks.  Things have improved greatly since the beginning of March, but I feel like I'm waiting for the other shoe to drop, as they say.  I guess it's just a matter of learning to live with this.

[Jo CIMDA]

That's really good news, and there is still a lot more improvement to come.

Monitor her clinical signs (the side effects of the drugs) and if you think things are not right take her back before the month is out.

Good luck
Jo