Smyroglou Ε. DVM, MSc student, Diagnostic Laboratory, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
Fasoula S. DVM, MSc student, Diagnostic Laboratory, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
Karakitsou V. DVM, MSc, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
Giapitzoglou S. DVM, MSc, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
Mylonakis M.E. DVM, PhD, Professor, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
Introduction
Evans syndrome is an uncommon human autoimmune disease defined by simultaneous or sequential immune-mediated hemolytic anemia (IMHA) and immune-mediated thrombocytopenia (ITP).
Clinical case
A five-year-old, intact male, Pekingese dog was admitted with a four-day history of inappetence, depression and bleeding diathesis.
Results
Major physical and laboratory abnormalities included mucosal pallor, cutaneous and mucosal petechiae and ecchymoses, melena, severe thrombocytopenia and, anemia. A diagnosis of primary ITP was established, based on the consistent clinical and clinicopathologic findings and the complete and sustained remission after the institution of immunosuppressive treatment, which was completed nine months later. Eight months later, the dog was readmitted with a two-day history of inappetence and weakness. Clinical and clinicopathologic evaluation indicated depression, fever, mucosal pallor, non-regenerative anemia, normal platelet count, spherocytosis, positive direct Coombs test and hyperbilirubinemia. Imaging and serology testing were unremarkable, supporting the diagnosis of primary IMHA. Following the implementation of immunosuppressive and antiplatelet medical treatment, hematologic remission was achieved within one week and maintained for the entire treatment period (7 months). The dog is doing well one and a half years after the cessation of medications.
Conclusions
To the authors, knowledge, this is the first report of canine sequential Evans syndrome in the literature.
References
- Evans RS, Takahashi K, Duane R T, Payne R & Liu C (1951) Primary thrombocytopenic purpura and acquired hemolytic anemia; evidence for a common etiology. AMA Arch Intern Me, 87, 48-65.
- Garden OA, Kidd L, Mexas AM, Chang YM, Jeffery U, Blois SL, Fogle JE, Macneill AL, Lubas G, Birkenheuer A, Buoncompagni S, Dandrieux J R S, Di Loria A, Fellman, C L, Glanemann B, Goggs R, Granick J L, Levine D N, Sharp C R, Smith-Carr S, Swann JW & Szladovits B (2019) ACVIM consensus statement on the diagnosis of immune-mediated hemolytic anemia in dogs and cats. Journal of Veterinary Internal Medicine 33, 313-334.
- Mccullough S (2003) Immune-mediated hemolytic anemia: understanding the nemesis. Vet Clin North Am Small Anim Pract 33, 1295-315.
