Transcript Case of the Month - Ross Bond

Crusting and ulceration
in a crossbred dog
Author: David Grant
Editor: David Lloyd
© European Society of Veterinary Dermatology
History – 1
•
•
•
•
2-year-old entire male crossbred dog
Weight 10 kg
Initial ‘sores’ on lip, nose, scrotum developed over ‘a
week or two’
Dog otherwise healthy. No pruritus.
Click to reveal the text on this screen
Click the forward arrow to jump to the next screen
History | Signs | Differentials | Tests | Therapy | Notes
History - 2
•
•
•
Treated with antibiotics and steroids
2 weeks later no response
Dog now shows malaise, anorexia
History | Signs | Differentials | Tests | Therapy | Notes
History - 3
•
•
•
•
•
•
No other history of dermatological disease
There is a healthy canary but no other animals in the
house
Owners have no lesions
No history of contact with or ingestion of irritant
substances
Rectal temperature 103oC
Depressed demeanour
History | Signs | Differentials | Tests | Therapy | Notes
Clinical signs - 1
Crusting, mucopurulent discharges and ulceration are
apparent at various sites
Ulceration and discharge
from the lids of the left eye
Ulceration of the lip margins
History | Signs | Differentials | Tests | Therapy | Notes
Clinical signs - 2
Crusting, exudation and
pustular lesions affecting
the footpads
History | Signs | Differentials | Tests | Therapy | Notes
How would you
approach this case?
•
•
•
•
What are the next steps you would take?
Make a list of your principle differential diagnoses
List any samples you would collect
List any tests you would perform to assist in making a
definitive diagnosis
History | Signs | Differentials | Tests | Therapy | Notes
Differential
diagnoses
•
•
Bullous pemphigoid, drug eruption, SLE,
mococutaneous candidiasis
Also ulcerative stomatitis, neoplasia,
dermatophytosis, secondary pyoderma
History | Signs | Differentials | Tests | Therapy | Notes
Tests - 1
•
•
•
•
Skin scrapings, Nikolsky test
Blood tests: routine haematology and
biochemical screens
Fungal culture of crusts and exudate
Multiple biopsy samples from intact
vesicles/pustules and edges of ulcers
History | Signs | Differentials | Tests | Therapy | Notes
Tests - 2
•
•
•
•
Scrapings from crusted areas did not reveal
ectoparasites or fungal structures
The Nikolsky sign was not elicited
Smears of exudate stained with Giemsa showed
coccoid and rod-shaped bacteria in moderate
numbers, neutrophils, and some acanthocytes
No satisfactory smears were obtained from intact
pustules or vesicles
History | Signs | Differentials | Tests | Therapy | Notes
What now?
•
•
•
What treatment should you now institute, if any,
whilst waiting for the fungal cultures and biopsy
results?
What are now your principle differential
diagnoses?
Are there any other samples you would collect
History | Signs | Differentials | Tests | Therapy | Notes
Tests - 3
•
•
•
Blood screens showed a slight neutrophilia but were
otherwise unremarkable
Fungal cultures were negative for dermatophytes or
yeasts
Histopathological examination of biopsy samples
revealed an intra- and sub-epidermal vesicular
dermatitis
History | Signs | Differentials | Tests | Therapy | Notes
Tests - 4
Histopathology
Acanthosis with suprabasilar
and some subepidermal
clefts. A lichenoid band of
inflammatory cells and some
pigmentary incontinence in
upper dermis and around
follicles
History | Signs | Differentials | Tests | Therapy | Notes
What is your
diagnosis?
•
•
Do the investigations permit a definitive diagnosis?
Are there any additional investigations which you think
may need to be done?
History | Signs | Differentials | Tests | Therapy | Notes
Diagnosis
•
Pemphigus vulgaris
• Lesion type, location and histopathology are consistent
• No history of previous drug therapy and histopathology
not consistent with EM and TEN
• Vesicles or bullae are subepidermal in bullous
pemphigoid
• Fungal culture was negative
History | Signs | Differentials | Tests | Therapy | Notes
How would you deal
with this case?
•
•
•
What is your prognosis?
How will you advise the owner?
What treatment would you consider?
History | Signs | Differentials | Tests
Tests | Therapy | Notes
Prognosis
•
Prognosis is guarded
• Disease can be fatal if not successfully treated
• Dogs may not tolerate steroids and other
immunomodulatory drugs
• Lifelong therapy is necessary
History | Signs | Differentials | Tests | Therapy | Notes
Therapy
•
Induction therapy - first 3 weeks
• Methylprednisolone orally, 5 mg/kg daily
• Azathioprine orally, 2.2 mg/kg every other day
History | Signs | Differentials | Tests | Therapy | Notes
Response to therapy
•
•
•
After 3 weeks the lesions were in remission
Therapy continued as
• Methylprednisolone, 2 mg/kg every other day
• Azathioprine, 2.2 mg/kg on the alternate days
At 6 months the dog was still in remission
History | Signs | Differentials | Tests | Therapy | Notes
Notes
Review
•
If you would like to review this case, please use the
navigation buttons below
History | Signs | Differentials | Tests | Therapy | Notes