Sudilar

I recently ran into the subject of Pemphigus while corresponding with a puppy owner whose dog has a T-cell Lymphoma. I lost my 11 yr old puppy to Lymphoma last year so I keep in touch with the Lymphoma crowd. Anyway her dog apparently has as part of the cancer a wild T-cell line that attacks the skin which results in a condition known as Paraneoplastic pemphigus (PNP). It appears to now be under control with the use of Cytoxin.

You might try getting a reprint of a very recent article in the European Society of Veterinary Dermatology (2004 Vol 15, 90-98) titled Pemphigus: current therapy. It might be possible to get an address off the Internet somewhere. A couple of interesting snippets...

The author claims Pemphigus vulgaris (PV) is a very rare form of pemphigus accounting for less than 0.1% of the referral cases in a dermatology specialty practice... This form requires the most aggressive forms of combination therapy.

The big question with all the problems your dog has experienced is how agressive is "agressive"?

Per glucocorticoids such as Prednisone the author suggests if the Pemphigus can not be controlled by every other day or once per 72 hr maintenance then other immune suppression agents should be used.

As mentioned above the author gives Azathioprine (a transplant anti-rejection drug) as a preferred choice, but then goes on to listing possible liver damage as a side effect. He discusses the use of Mustard agents such as Leukeran (0.1-0.2 mg/kg every 24-48 hrs) . I have not been able to find any citations indicating liver damage as a possible effect of Leukeran. In fact it is used against cancer after it has spread to the liver. You need to ask questions about it. My puppy never received Leukeran, but instead Cytoxin another Mustard. I commonly gave both Metoclopromide, and Cimetidine as supportive drugs. Never had any GI problems with the Cytoxin. Leukeran would probably behave in the same manner.

BTW- I note you don't list a stomach acid blocker being used. If you are not using one, then get your puppy on Cimetidine or Rantidine as soon as possible to help heal the ulcerations the Prednisone is causing. I gave my 90 lb baby 200 mg Cimetidine 2X daily during Chemo and especially when on Prednisone. Check with your Vet for the dosage to give to your puppy.

An adjunct treatment the article lists is Tetracycline + Niacin. Only problem is that the Niacin might cause liver problems. Oops the Tetracycline can also cause liver shunting. So much for that therapy.

If you decide to discuss with your Vet the possibility of using Leukeran you will have to monitor the bone marrow function via blood tests. Given that the Prednisone has already suppressed the immune system, it's going to be a balancing act withdrawing from it, while switching to increasing doses of Leukeran. You'll definitely have to keep the puppy on the amoxicillin, and if you run into any infections before getting things stabilized have another antibiotic such as Baytril at the ready.

Hopefully you can get off the Prednisone while keeping the Pemphigus under control.