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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - CALCINOSIS CUTITIS
| Good and bad news about Chloe. Her HCT Sept.8 was 39.5, retic 24,000 and lymphocytes 744. Her prednisone went down to 5 mg/day today. Her cyclosporine is now at 200 mg/day and goes down to 150 mg/day on Monday. That is the good news. The bad news is that she now has multiple surface skin lesions (some infected) and is on antibiotics. The vet says that they are CALCINOSIS CUTITIS. Some of them are a raised dirty gray and some appear to have whitish pebbles under the skin. She also has very large thickened, movable sections of tissue under her skin (some ranging in size from 4- 6 inches by 3 inches);these are huge and about 1/2 or so in thickness. They are mostly over her shoulder and thigh bones. They are not causing her any pain that I can tell. The vet said they are drug induced and will go away. I truly don't believe this and from what I have read if they are huge calcium deposits they are surgically removed. These large tumor like plates are what concern me the most. I can't figure out if I need an internist, dematologist, surgeon or oncologist! I do think I have to take her to Penn though I just hate to do a biopsy on her now that the IMHA is getting better. Oh-she also has one visible papilloma on her lip and the lesions in her mouth are much smaller. She has no itching with any of the lesions. There is no fur lost over the lesions and in fact some belly hair is growing back (just in time to be shaved again for a laparoscopic spay). Has anyone heard of these type of lesions? I didn't do a chemistry panel as her liver meds take 4-6 weeks to work. She is not on any calcium meds but apparently the iatrogenic Cushing's that she has from the high dosage of prednisone can cause the calcinosis cutitis. At one point she was on 80 mg/day. It figures that if something odd will happen, it would happen to Chloe. Happily though she is regaining strength and spending more time awake. Her muscles are just starting to regain some tone. The Cushing's from the prednisone was quite pronounced just like her huge belly. I didn't know tumors came with Cushing's though. I still would have done the same treatment for the IMHA, just wish I had a crystal ball. Cheri and Chloe |
| Cheri Maryland |
| Cheri ... our older Vizsla, who had cushings syndrome, had significant amounts of calcinosis cutis. From my experience with him .. once treated with Lysodren (one of the drugs to treat cushings syndrome) and his cortisol levels had reduced to what is recommended whilst being treated (which is lower that you would have for a "normal" dog) the calcinosis cutis stopped progressing. Some of the shallower deposits rose to the surface and disappeared completely but the rest of them just remained there. He lived with these for two years until he passed away in March. They only bothered him when his cortisol levels were too low. Sabre's were located mainly either side of his spine, around his ears and his anal area. Calcinosis cutis can arise with iatrogenic cushings. If you do a search on the internet you will find some pictures of calcinosis cutis. It is a symptom of cushings however it is not very common - most vets will never see a case in their career. I am a member of a cushings forum and we only have seen three cases over the last three years. I would have to disagree with your vet and say that the larger, thicker areas are unlikely to disappear. You can surgically remove them ... but with an IMHA dog I personally wouldn't go there - as I said earlier, the calcinosis cutis does not cause any pain or discomfort to the dog. What I do recommend is that you need to try and keep on top of controlling infections with them. As your pred is reduced this should be easier to control. We used a number of things ... we tried medicated shampoos (not sucessful for Sabre), oatmeal shampoos (worked really well), betadine to dry the areas and antibiotics when infections looked likely. Once he was treated for his cushings and his hair grew back it was never an issue. I should add that you do not "treat" iatrogenic cushings, it is the eventual removal of the prednisone which will reverse these cushings like symptoms - however, from our experience, the larger calcinosis cutis dose not disappear. If you have any more queries ... or my explanation isn't clear enough please ask away. Angela and Flynn (IMHA) |
| Angela New Zealand |
| Thank you so much Angela. Your post was very helpful. The lesions are completely covered by her fur right now. The shaved areas (for bone marrow and ultrasound) have no lesions. I only discovered them by accident when blow drying her fur after a bath.I didn't think the really large thick areas could disappear but hopefully they might decrease in size a bit. I think she will always be on a small amount of prednisone though as she has already had one relapse only two months into treatment for IMHA. A medicated shampoo or anything involving a bath is going to be a nightmare as I have to go to a public dog wash because she is too heavy at 79 pounds (12 pounds over pre-illness weight) to be lifted into a deep soaking tub. Most of the lesions are actually dry and lumpy, looking like pearls just below the surface. There was only one of many that was oozing slightly so she was put on Keflex generic two days ago. I am just so glad there doesn't seem to be any pain involved. No one else has really mentioned this type of lesion. I think though that as Chloe loses the prednisone weight the very large deeper lesions might create a problem for her. She seems to be walking okay but she still is very weak from the drugs. This is a real long road but at least I see some light and she is alive... and that is the best I can hope for. Her perky and sweet personality are returning. I might have found the deeper lesions earlier but I didn't do deep exploration of her chest, etc. when she was so very ill. If this is so rare, I should be thankful that our vet so quickly identified the lesions. Cheri and calcinosis cutitis Chloe |
| Cheri Maryland |
| You are more than welcome Cheri. If baths are a nightmare .. the first and foremost is to try and keep them dry and free of infection. You are doing a fantastic job ... just continue to do a quick check every day so that you can keep on top of the moist areas and infections. Angela and Flynn |
| Angela New Zealand |
| Hi Cheri. My dog also developed calcinosis cutis. Oddly enough it manifested as we were reducing the prednisone and were getting into the lower doses; we were at 10 mg./day down from the original 80 mg./day. Duck did have iatrogenic cushings though and calcinosis cutis is one of the symptoms. He had small hard white bumps all along his spine that didn't bother him and we were fortunate that none of them became infected. We didn't treat the bumps with anything and eventually they disappeared. It sounds like Chloe is doing well otherwise if she is more alert and regaining her strength. Those are all good signs. Good luck to you both. deb and Duck |
| Debbie BC Canada |
| Cheri, if I were you I would try to find a consult with a TCVM to help with this. Dermatologic issues (fromm all I've seen and read) are usually best treated with a combo of western methods as well as holitic means. TCVM has worked wonders for skin issues in dogs. Try tcvm.com and use their locator to see if there are any near you. Unfortunately for me there were none up here in Nova Scotia. Tessy went through very similar skin issues and they all went away once the drugs were lowered and discontinued. Give Chloe lots of hugs and scritches for me. Johnny & Tessy |
| Johnny |
This thread was discussed between 11/09/2010 and 13/09/2010
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