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Immune Mediated Meningoencephalitis

by artemys2 - June 27, 2017

Hi, I will be seeing a new patient, "Riley", on Thursday. He is a 6 yr old, MN, Jack Russel Terrier who started out with neck pain at the beginning of June and then developed seizures on 6/8/17. An MRI was performed and he was diagnosed with immune mediated meningoencephalitis. There were also eosinophils in his CSF so infectious causes like cryptococcus or neopaspora can't be ruled out and titers are pending. CBC and Chem were normal although I don't have the actual results to confirm. The neurologist has him on Prednisone 10 mg in am and 5 mg in pm, zonisamide 100 mg - 1 PO BID, famotidine 10 mg - 1 PO SID. He developed diarrhea on the medications and was started on metronidazole 125 mg BID.
The neurologist was talking with the owner about options for long-term treatment, including cytarabine, procarbazine, and cyclosporine. The owner got concerned about all the medications and starting more and contacted me. Since starting the medications he has had no seizures.
Since I have not yet seen the client I can't give you a tongue or pulse description. I was considering herbs like xiao chai hu tang for its immune effects and Long Dan Xie Gan Tang. I have never treated meningoencephalitis with herbs before and any guidance you could give would be greatly appreciated.
Thanks and many blessings,
Jen

by artemys2

June 29, 2017

Just saw this patient. Tongue is red, lavender, thin, dry and pulses were thin and slippery. I find it hard to determine actual tongue and pulse of patients that are on prednisone. The tongues always look red and thin to me.
The Neuro PCR panel for protozoa and fungus came back negative for 13 different organisms.
Riley is doing great on the prednisone and Zonisamide. Has not had a seizure since starting these medications.
I started him on Boswellia Complex from MediHerb which has good penetration through the BBB to help with inflammation and neurotrophin PMG. I am waiting to start herbs until I hear back from yu but will be seeing Riley for acupuncture as well.
Thanks,
Jen

by naturevet

June 30, 2017

Hi Jen,

First, just a reminder to post case questions through the 'Ask a Case Question', if you can. That way they get added to the database and will one day be potentially used in a case series to advance the field

The standard treatment holistically speaking for this is Chai Ge Jie Ji Tang. It is almost invariably curative (meaning I've never seen a case that was not, but I'm sure it could happen at some point). Kan Essentials sells this as Bupleurum and Kudzu Clearing Formula.

If flagyl helped the diarrhea, then Si Miao San is an option, perhaps in addition if needed. By itself it could address the seizures, but I've never used it for meningo-encephalitis

I don't think you're going to need all the drugs that were proffered, and you should be able to eventually discontinue most if not all of what the dog is on. The pulse will be your guide. When that slippery superficial pulse goes away, the dog should be at much less risk for problems, and you can judiciously start the weaning process

Good luck!

Steve

by artemys2

July 1, 2017

Sorry, I will use the Ask a Case Question function next time. Thanks you so much for your reply and it definitely makes me feel safer weaning this patient off the pharmaceutical drugs when the time comes.
Thanks for all your help and guidance!
Jen

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