Treatment of Evans’ Syndrome With Human Intravenous Immunoglobulin and Leflunomide in a Diabetic Dog

ArticleinJournal of the American Animal Hospital Association 45(3):147-50 · May 2009with15 Reads
DOI: 10.5326/0450147 · Source: PubMed
An 11-year-old, spayed female miniature schnauzer with diabetes mellitus was presumptively diagnosed with Evans' syndrome (ES). Because of the potential adverse effects of immunosuppressive doses of glucocorticoids in a diabetic dog, a single infusion of human intravenous immunoglobulin and oral leflunomide were used as first-line immunomodulatory therapy, after informed owner consent was received. This treatment resulted in complete remission of the ES, and leflunomide was discontinued after 10 months of therapy. Over a 19-month follow-up, the dog did not relapse and has remained a well-regulated diabetic.
    • "Despite reported usage, the efficacy of other agents (cyclophosphamide, azathioprine and danazol) in canine IMTP is not documented by controlled studies or limited to very small numbers of cases ( Williams and Maggio-Price 1984, Jackson and Kruth 1985, Bloom and others 1989, Jans and others 1990, Roseler and Mason 1994). Leflunomide monotherapy eventually maintained normal platelet counts in two of three dogs previously receiving other therapies (Gregory and others 1998b) and a combination of leflunomide and IVIG was recently described for successful management of Evans' syndrome in a dog (Bianco and Hardy 2009). Ciclosporin has also been described for successful management of chronic IMTP refractory to prednisolone in three dogs, although a fourth dog died from systemic aspergillosis that may have been precipitated by immunosuppression (Cook and others 1994). "
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