한국임상수의학회지 (Journal of Veterinary Clinics)

  • 제40권4호
  • /
  • Pages.288-293
  • /
  • 2023
  • /
  • 1598-298X(pISSN)
  • /
  • 2384-0749(eISSN)
한국임상수의학회 (The Korean Society of Veterinary Clinics)
권호 표지
DOI QR코드

DOI QR Code

Evans' Syndrome Induced by Rabies Vaccination in a Dog

  • Yeji Kim (Department of Veterinary Internal Medicine, College of Veterinary Medicine, Chonnam National University) ;
  • Jihyun Kim (Department of Veterinary Internal Medicine, College of Veterinary Medicine, Chonnam National University) ;
  • Yunji Song (Department of Veterinary Internal Medicine, College of Veterinary Medicine, Chonnam National University) ;
  • Songju Oh (Department of Veterinary Internal Medicine, College of Veterinary Medicine, Chonnam National University) ;
  • Ha-Jung Kim (Department of Veterinary Internal Medicine, College of Veterinary Medicine, Chonnam National University)
  • 투고 : 2023.06.20
  • 심사 : 2023.07.31
  • 발행 : 2023.08.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

A 11-year-old neutered male Maltese dog was vaccinated with a rabies vaccine (Rabisin®, Boehringer Ingelheim International GmbH, Germany) subcutaneously at a local animal hospital. One hour after vaccination, purpura with edema was observed at the injection site and severe thrombocytopenia (0 K/μL) was noted on a complete blood count (CBC). No specific findings were found in serum chemistry, electrolyte, blood gas analysis, and coagulation tests. The patient was hospitalized and administered antihemorrhagic agents (vitamin K, desmopressin), antihistamines (chlorpheniramine) and corticosteroids (methylprednisolone sodium succinate). On a repeat CBC, mild anemia had developed, thrombocytopenia was still noted, and autoagglutination was observed on a saline agglutination test (SAT). A polymerase chain reaction panel for infectious agents (e.g., Babesia spp.) was negative. The diagnosis was secondary immune-mediated thrombocytopenia (IMT) with immune-mediated hemolytic anemia (IMHA) associated with vaccination. Therefore, the immunosuppressants (prednisolone, and mycophenolate mofetil) were administered. Six days after drug administration, new lesion was not observed, and the previous lesions were significantly improved. It gradually improved and 4 weeks after hematocrit and platelet recovered to normal levels. It was maintained for 6 months without recurrence of related symptoms. Based on patient's history and test results, the patient was diagnosed with Evans' syndrome associated with rabies vaccine.

키워드

과제정보

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Education (NRF-2023R1A2C1005348).

참고문헌

  1. Ackermann AL, May ER, Frank LA. Use of mycophenolate mofetil to treat immune-mediated skin disease in 14 dogs - a retrospective evaluation. Vet Dermatol 2017; 28: 195-e44. 
  2. Chang SK, Farrell DL, Dougan K, Kobayashi B. Acute idiopathic thrombocytopenic purpura following combined vaccination against measles, mumps, and rubella. J Am Board Fam Pract 1996; 9: 53-55. 
  3. Cummings FO, Rizzo SA. Treatment of presumptive primary immune-mediated thrombocytopenia with mycophenolate mofetil versus cyclosporine in dogs. J Small Anim Pract 2017; 58: 96-102.  https://doi.org/10.1111/jsap.12621
  4. Dewey CW, Cerda-Gonzalez S, Fletcher DJ, Harb-Hauser MF, Levine JM, Badgley BL, et al. Mycophenolate mofetil treatment in dogs with serologically diagnosed acquired myasthenia gravis: 27 cases (1999-2008). J Am Vet Med Assoc 2010; 236: 664-668.  https://doi.org/10.2460/javma.236.6.664
  5. Dodds WJ. Immune-mediated diseases of the blood. Adv Vet Sci Comp Med 1983; 27: 163-196. 
  6. Dosi RV, Ambaliya AP, Patell RD, Patil RS, Shah PJ. A case report of Evans Syndrome. Indian J Med Sci 2012; 66: 82-85.  https://doi.org/10.4103/0019-5359.110920
  7. Ettinger SJ, Feldman EC, Cote E. Textbook of veterinary internal medicine: diseases of the dog and the cat. 8th ed. St. Louis: Elsevier. 2017. 
  8. Evans RS, Takahashi K, Duane RT, Payne R, Liu C. Primary thrombocytopenic purpura and acquired hemolytic anemia; evidence for a common etiology. AMA Arch Intern Med 1951; 87: 48-65.  https://doi.org/10.1001/archinte.1951.03810010058005
  9. Frana TS, Clough NE, Gatewood DM, Rupprecht CE. Postmarketing surveillance of rabies vaccines for dogs to evaluate safety and efficacy. J Am Vet Med Assoc 2008; 232: 1000-1002.  https://doi.org/10.2460/javma.232.7.1000
  10. Grimaldi-Bensouda L, Michel M, Aubrun E, Leighton P, Viallard JF, Adoue D, et al. A case-control study to assess the risk of immune thrombocytopenia associated with vaccines. Blood 2012; 120: 4938-4944.  https://doi.org/10.1182/blood-2012-05-431098
  11. Hogenesch H, Azcona-Olivera J, Scott-Moncrieff C, Snyder PW, Glickman LT. Vaccine-induced autoimmunity in the dog. Adv Vet Med 1999; 41: 733-747.  https://doi.org/10.1016/S0065-3519(99)80056-1
  12. Jackson ML, Kruth SA. Immune-mediated hemolytic anemia and thrombocytopenia in the dog: a retrospective study of 55 cases diagnosed from 1979 through 1983 at the Western College of Veterinary Medicine. Can Vet J 1985; 26: 245-250. 
  13. Joshi BC, Jain NC. Detection of antiplatelet antibody in serum and on megakaryocytes of dogs with autoimmune thrombocytopenia. Am J Vet Res 1976; 37: 681-685. 
  14. Klag AR, Giger U, Shofer FS. Idiopathic immune-mediated hemolytic anemia in dogs: 42 cases (1986-1990). J Am Vet Med Assoc 1993; 202: 783-788.  https://doi.org/10.2460/javma.1993.202.05.783
  15. Martinez E, Domingo P. Evans's syndrome triggered by recombinant hepatitis B vaccine. Clin Infect Dis 1992; 15: 1051. 
  16. O'Leary ST, Glanz JM, McClure DL, Akhtar A, Daley MF, Nakasato C, et al. The risk of immune thrombocytopenic purpura after vaccination in children and adolescents. Pediatrics 2012; 129: 248-255.  https://doi.org/10.1542/peds.2011-1111
  17. Orcutt ES, Lee JA, Bianco D. Immune-mediated hemolytic anemia and severe thrombocytopenia in dogs: 12 cases (2001-2008). J Vet Emerg Crit Care (San Antonio) 2010; 20: 338-345.  https://doi.org/10.1111/j.1476-4431.2010.00540.x
  18. Phillips TR, Jensen JL, Rubino MJ, Yang WC, Schultz RD. Effects of vaccines on the canine immune system. Can J Vet Res 1989; 53: 154-160. 
  19. Piek CJ. Canine idiopathic immune-mediated haemolytic anaemia: a review with recommendations for future research. Vet Q 2011; 31: 129-141.  https://doi.org/10.1080/01652176.2011.604979
  20. Pulendran B, Ahmed R. Immunological mechanisms of vaccination. Nat Immunol 2011; 12: 509-517.  https://doi.org/10.1038/ni.2039
  21. Putra A, Austel M, Banovic F. A retrospective evaluation of the steroid sparing effects of oral mycophenolate mofetil (MMF) as an adjunct immunosuppressant for the treatment of canine pemphigus foliaceus. Vet Dermatol 2022; 33: 77-e24. 
  22. Putsche JC, Kohn B. Primary immune-mediated thrombocytopenia in 30 dogs (1997-2003). J Am Anim Hosp Assoc 2008; 44: 250-257.  https://doi.org/10.5326/0440250
  23. Rajantie J, Zeller B, Treutiger I, Rosthoj S; NOPHO ITP working group and five national study groups. Vaccination associated thrombocytopenic purpura in children. Vaccine 2007; 25: 1838-1840.  https://doi.org/10.1016/j.vaccine.2006.10.054
  24. Sauve LJ, Bettinger J, Scheifele D, Halperin S, Vaudry W, Law B; Canadian Immunization Monitoring Program, and Active (IMPACT). Postvaccination thrombocytopenia in Canada. Pediatr Infect Dis J 2010; 29: 559-561.  https://doi.org/10.1097/INF.0b013e3181d2bb45
  25. Scott MA, Jutkowitz LA. Immune-mediated thrombocytopenia. In: Weiss DJ, Wardrop KJ, editors. Schalm's veterinary hematology. 6th ed. Ames: Blackwell Publishing. 2010: 586-595. 
  26. Shlamovitz GZ, Johar S. A case of Evans' syndrome following influenza vaccine. J Emerg Med 2013; 44: e149-e151.  https://doi.org/10.1016/j.jemermed.2012.01.060
  27. Switzer JW, Jain NC. Autoimmune hemolytic anemia in dogs and cats. Vet Clin North Am Small Anim Pract 1981; 11: 405-420.  https://doi.org/10.1016/S0195-5616(81)50036-2
  28. Tizard I. Risks associated with use of live vaccines. J Am Vet Med Assoc 1990; 196: 1851-1858.  https://doi.org/10.2460/javma.1990.196.11.1851
  29. Viviano KR. Update on immununosuppressive therapies for dogs and cats. Vet Clin North Am Small Anim Pract 2013; 43: 1149-1170.  https://doi.org/10.1016/j.cvsm.2013.04.009
  30. Wang A, Smith JR, Creevy KE. Treatment of canine idiopathic immune-mediated haemolytic anaemia with mycophenolate mofetil and glucocorticoids: 30 cases (2007 to 2011). J Small Anim Pract 2013; 54: 399-404.  https://doi.org/10.1111/jsap.12107
  31. West LD, Hart JR. Treatment of idiopathic immune-mediated hemolytic anemia with mycophenolate mofetil in five dogs. J Vet Emerg Crit Care (San Antonio) 2014; 24: 226-231.  https://doi.org/10.1111/vec.12121
  32. Willard MD, Tvedten H. Small animal clinical diagnosis by laboratory methods. 5th ed. St. Louis: Elsevier Saunders. 2012. 
  33. Williams DA, Maggio-Price L. Canine idiopathic thrombocytopenia: clinical observations and long-term follow-up in 54 cases. J Am Vet Med Assoc 1984; 185: 660-663.