Combination therapy of cyclosporine and prednisolone in a dog with systemic lupus erythematosus

Abstract

Abstract : An 11-year-old, spayed female poodle presented with fever and shifting lameness. Physical examinationrevealed hyperthermia (40.6 o C), and proteinuria was detected upon urinalysis. Increased neutrophils (83%) and decreasedviscosity were revealed upon synovial fluid analysis. Serum antinuclear antibody was positive at 1 : 80. Based on thesefindings, the dog was diagnosed with systemic lupus erythematosus. Immunosuppressive therapy was initiated withprednisolone and cyclosporine, and the condition was markedly improved after the treatments. This case report describesthe clinical and laboratory findings, imaging characteristics and successful outcomes after prednisolone plus cyclosporinetherapy in a canine systemic lupus erythematosus case.Keywords : antinuclear antibody, cyclosporine, glomerulonephritis, polyarthritis, systemic lupus erythematosus Systemic lupus erythematosus (SLE) is a multisystemicautoimmune disorder in which immunity is directed againstvarious tissues or tissue components [1]. The most commonclinical features include shifting lameness from polyarthritis,ulceration of extremities caused by vasculitis, icteric and palemucous membranes resulting from immune-mediated hemol-ysis, and peripheral edema or pleural effusion due to hypoal-buminemia secondary to glomerulonephritis. Additionally,dermatologic lesions may be present, including crusting, alope-cia, erythema, ulceration, and hyperkeratosis [8].Major signs of SLE are skin lesions, non-erosive polyarthri-tis, hemolytic anemia, glomerulonephritis, polymyositis, leuko-penia, and thrombocytopenia [1]. Minor signs are fever, centralnervous system symptoms, oral ulcerations, lymphadenopa-thy, pericarditis, and pleuritis [2]. The antinuclear antibody(ANA) test and lupus erythematosus (LE) cell preparations areused clinically for the diagnosis of SLE, but until recently, theANA test is considered the most sensitive [3, 14]. Immunosup-pression is vital to treating this abnormal immune response,and patients can be treated with high dose of prednisolone (1–2 mg/kg, per oral [PO], q12h) and cytotoxic drugs, such asazathioprine, cyclosporine, and cyclophosphamide [4, 5]. Thiscase report describes successful treatment using prednisoloneand cyclosporine in a dog with SLE.An 11-year-old, 6.1 kg, spayed female poodle dog pre-sented with fever, lethargy, anorexia, and shifting lameness.The dog had a history of reluctance to stand up and walk,which was intermittent and partially responsive to non-steroi-dal anti-inflammatory drugs. Physical examination was unre-markable except for hyperthermia (40.6