This case report demonstrates the efficacy of an integrated approach that combined prednisone with TCVM, nutritional support, and homeopathy for the treatment of vaccine-induced meningoencephalitis.

Introduction

A three-year-old castrated male Australian Shepherd was diagnosed with suspected vaccine-induced meningoencephalitis, causing sudden onset and progressive hind limb weakness and ataxia, as well as anorexia and lethargy. The dog responded well to a combination of conventional therapy (Western medicine), Traditional Chinese Veterinary Medicine (TCVM), body support supplements, and homeopathy. The addition of integrative therapies to the original conventional treatment plan allowed for the corticosteroid dose to be tapered, and improved the overall quality of life for the dog.

Explanation of case-selection

As part of my training at Auburn University College of Veterinary Medicine, I was tasked with completing an externship to address a problem commonly faced in veterinary medicine — the lack of therapeutic options for patients with chronic disease, immunosuppression, and/or comorbidities. Due to these barriers, veterinarians recommending treatment modalities need to incorporate integrative medicine into their practices to offer alternative therapies for these patients.

When selecting a veterinary practice to complete my externship, I noticed that PAZ Veterinary, in Austin, Texas, utilizes acupuncture, herbal therapy, food therapy, and cold laser treatments. These alternative therapies can improve the quality of life and possibly extend the lifespan of many patients. Additionally, there may be serious side effects associated with the administration of opioids, NSAIDs and steroids, which can be avoided through the application of integrative medicine in everyday practice.

During my two weeks at PAZ, I selected a case in which a patient was immunosuppressed or suffered from chronic disease, and utilized integrative medicine therapeutic options to enhance the animal’s quality of life, treat the disease(s), and/or extend his lifespan.

Presentation

The patient presented to a specialty hospital for hind limb ataxia, lethargy, and decreased appetite. He was drinking normally, with no history of coughing, sneezing, diarrhea or vomiting. He was on monthly heartworm and flea and tick control and had just received his annual vaccinations, along with his first leptospirosis vaccine, a few days prior to presentation.

On physical examination, back pain was elicited, with potential etiologies including disc disease, infectious disease, immune-mediated disease, or cancerous processes.

Diagnostic workup

The patient was evaluated with the following tests: complete blood count, serum biochemistry, cerebrospinal tap, and a 4Dx Neospora, Cryptococcus, and neuro PCR panel. Imaging included lateral lumbar radiographs and an MRI of the cervical and thoracic spinal cord. All tests were within normal limits except for a slight elevation in the patient’s liver enzymes.

Initial treatment and response

The patient was initially treated for two weeks with prednisone at 0.5 mg/kg by mouth twice daily. At a recheck examination performed two weeks later, the dog’s owner reported he had remained ataxic and required a sling for assistance for about one week after initial treatment; however, upon presentation, the patient’s appetite was increased and the ataxia had resolved. Due to his positive response to steroids, steroid-responsive meningitis was the top differential. The prednisone dose was increased to 1 mg/kg by mouth twice daily.

Revaccination and return of symptoms

Because the dog was doing well at home and was appearing to go into remission, his owner subsequently scheduled an appointment for him to receive his second leptospirosis vaccine booster. The patient relapsed within 48 hours following the vaccination, and returned to the specialty hospital with ataxia and hind limb weakness. No other recent changes were noted in his lifestyle at this time. Mycophenolate at 10 mg/kg by mouth twice daily was added to his medications.

Integrative medicine consultation — assessment and treatment plan 

The patient then presented to the author for a second opinion and an integrative medicine consultation, at which time several alternative therapies were discussed.

On the TCVM physical examination, the patient showed a Qi deficiency; his mouth was slightly wet and muscle atrophy was present bilaterally on his head. The dog’s ears were hot and his tongue was red and cracked, suggesting a Yin deficiency or Heat excess. His carpal and tarsal pads were dry (suggesting a blood deficiency or Heat excess), and his nose was dry and cracked (suggesting a fluid deficiency +/- excess or a Yin deficiency). The patient was determined to be a mixture of Metal and Earth constitutions. He was sociable and relaxed yet exhibited muscle weakness, which is a characteristic of the Earth element. He also had a good hair coat, and according to his guardians, he loved order and obeyed rules, all of which are attributes of the Metal element.

• To treat the hind limb weakness and ataxia, weekly acupuncture sessions were recommended to help bring blood flow to the areas of weakness and stimulate the nerves to regain muscle strength. Acupuncture point selection was based on the TCVM pattern diagnosis of Kidney Qi deficiency, Yin deficiency, and excess Heat with Wind invasion. If improvement was noted, the acupuncture sessions would be continued once per month, until improvement could be seen in the patient’s overall muscle condition. The first acupuncture session was performed at this initial appointment.
• Bupleurum and Kudzu, Chinese herbs useful for the treatment of meningitis, were chosen because they are known to support a healthy nervous system and spinal cord by addressing the Heat lodged in the joints, muscles, and nerves along the back.
• Nutritional whole body support was provided by Canine Mushroom Matrix to help improve the patient’s excess Heat and Yin deficiency imbalances, as well as support the overall Qi in the body.
• Due to the elevation in liver enzymes, and to help support the metabolism of the pharmaceuticals, Rx Vitamins for Pets Hepato Support was prescribed at one to two capsules orally every 12 hours.
• Homeopathic Thuja occidentalis was prescribed to detoxify the patient from vaccination administration. Thuja is an effective homeopathic to help resolve symptoms associated with vaccination, such as lethargy, muscle weakness, muscle pain, and gastrointestinal disturbances when present.

Due to the strong correlation between the initial onset of clinical signs and the recent relapse after vaccine booster administration, subsequent titer testing for canine distemper virus, canine parvovirus type 2, canine adenovirus type 1, and rabies was strongly recommended for this patient, to avoid another possible relapse. Although law requires a rabies vaccination, exemptions may be granted in certain states. Lastly, if the patient is determined to be at low risk for exposure, the need for leptospirosis vaccination may be reconsidered in the future.

Case progress

One week after beginning integrative treatment, the dog exhibited increased energy and playfulness. The prednisone dose was reduced to 0.75 mg/kg by mouth twice daily. A recheck involving a complete blood count and chemistry panel were recommended in three weeks, along with a further reduction in the prednisone dose if the patient continued doing well. The second acupuncture session was scheduled in one week’s time; if the patient tolerated it well, electroacupuncture would be considered for future sessions; EA would allow for an adjustment of the frequency and intensity of the impulse being delivered through the needles.

Summary

The patient had a sudden episode of acute onset hind limb ataxia and weakness, along with decreased appetite. The only major change in his lifestyle was the administration of vaccinations a few days prior to the presentation of clinical signs. After a range of diagnostic testing was performed and differentials were ruled out, including disc disease, infectious disease, and cancerous processes, the main differential remaining was meningoencephalitis of unknown origin (MUO). Prednisone was administered to suppress the immune system because an immune-mediated response was highly likely at this point.

At the patient’s next recheck, he responded very well to the prednisone therapy and appeared to have gone into remission. At that time, steroid-responsive meningitis was the presumptive diagnosis. The patient was kept on prednisone to ensure complete recovery and avoid a relapse.

Due to his recovery, a booster vaccination was given about one week later; the patient immediately relapsed about 48 hours after the vaccine and exhibited the previous clinical signs of hind limb ataxia and weakness.

Although the pathogenesis of this patient’s clinical presentation is beyond the scope of this paper, this case demonstrates the need for awareness of vaccine-related disease as well as the benefits of integrating protocols from both conventional and complementary modalities during treatment.

Declaration of interest

The author declares that there is no conflict of interest which could be perceived as prejudicing the impartiality of this paper.

 Funding

The author did not receive any specific grant or funding from any organization in the public, commercial, or non-profit sectors.

References

Ma A. Clinical Manual of Chinese Veterinary Herbal Medicine. Mainland Acupuncture publishing 2016.

Xie H, Preast V. Traditional Chinese Veterinary Medicine: Fundamental Principles, 2nd Edition. Tianjin, China: Chi Institute Press 2013.

Xie H, Preast V. Xie’s Veterinary Acupuncture. Ames Iowa. Blackwell Publishing, 2007.