Question Details
Pulmonary Eosinohilia In A Dog
by drwells - August 31, 2021    View Case Report
7 Year old FS GSD with 2-3 month history of reduced stamina and lethargy.
Sunshine is a very quiet, aloof GSD but calm and sweet once she knows you. I think she is Metal. She does come from a hoarding situation in the NE.
Initially presented for some hindlimb weakness due to mild OA in hips.
TCM dx at the time was bony bi due to kidney yin def as well as some damp signs : loose stools on occasion, decreased appetite (tongue was lavender, pulses: slippery and deep, prefers cool, appetite ok, thirst increased.
Doing well with AP and Hindquarter weakness (JT)
About 2 months ago: o noted wheezing (no coughing) and reduced stamina and fever. Rads showed diffuse bronchointerstitial pattern. Long story short, fecal negative, dewormed with Pancaur in case lungworm, fungal considered but rads not typical, not sick enough and no travel history (but still possible) , started doxy (appetite decreased): no significant response. In meantime, blood work showed persistent significant eosinophilia and basophilia with mod increase in WBC. ACTH normal although baseline cortisol low at 1.1
As we d/c doxy since was not improving clinical signs and causing decreased appetite, her WBC normalized, but eosinohilia persists (marked elevation). Abd u/s revealed splenomegaly: FNA of spleen normal
We are concluding PIE from a traditional perspective.
We are not excited about simply adding cyclosporine.
TCM currently: Her energy is improving daily, becoming more engaged with family again, appetite is better but stamina is still reduced.
I think she has underlying kidney yin def which developed into wei/lung qi def and invasion of external pathogens due to Shao Yang disharmony.
I would like advice on herb combination to start that may address the above as well as specific effect to reduce the eosinohilia and perhaps mimic the effects of pred (theoretically pred would "cure" the eosinohilia according to internal medicine gurus) while supporting her immune system. She is getting better, but needs some additional help.
A very sweet dog (and I am not a fan of German Shepards).
Thanks so much
Hannah
Replies
by naturevet
September 2, 2021
Hi Hannah,

I like your thinking.

For a (presumed) pred-responsive immune condition, with associated Qi deficiency (causing inappetance, loose stools, wheezing, poor stamina) and probably Shao Yang disharmony (causing splenomegaly and hip issues), I would think about Xiao Chai Hu Tang and Bu Zhong Yi Qi Tang. They work well together, with the latter supporting the Source and Wei Qi (and adrenals) and the former rectifying the probably underlying cause of the Qi deficiency, namely a Shao Yang disharmony.

Check in on the hemogram a couple of weeks in, just to make sure that in the course of tonifying the Wei Qi, you aren't making the eosinophilia worse. The XCHT should prevent that, though. If the owner decides to roll in pred, you will likely get by with a much lower dose than would otherwise have been needed to successfully treat the dog. The formulas are both compatible with pred.

Hopefully that helps you out. Please let us know how this goes. We don't see that many cases of PIE on the forum!

Steve
by drwells
September 2, 2021
Fantastic. Thank you. I have 29 years of vet med under my belt and honestly can't remember seeing a case of PIE either...Cool case. Fantastic dog. Thanks again so much for your help. I will keep you all posted.
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