Transcript Case of the Month

Generalised scaling in
a male donkey
Author: Mark Craig
Editor: David Lloyd
© European Society of Veterinary Dermatology
History
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10-year-old entire male donkey
First signs
• Reduced appetite, weight loss, generalised scaling
• In progress over a 3-month period
Treatment by referring vet
• Intramuscular penicillin/streptomycin daily for 10
days
• No improvement
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History | Signs | Differentials | Tests | Therapy | Notes
Clinical signs - 1
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Generalised exfoliative erythroderma
Thin, depressed
Rectal temperature, pulse rate, respiratory rate
normal
No peripheral lymphadenopathy
No oral lesions were present
History | Signs | Differentials | Tests | Therapy | Notes
Clinical signs - 2
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The donkey is thin
and depressed
There is poor coat
with generalised
scaling
History | Signs | Differentials | Tests | Therapy | Notes
Clinical signs - 3
Exfoliation and erythema
of the scrotum
Periocular scaling and greasy
matted hair around the eye
History | Signs | Differentials | Tests | Therapy | Notes
Clinical signs - 4
Close up of scaling,
matting of coat and
underlying erythema
History | Signs | Differentials | Tests | Therapy | Notes
How would you
approach this case?
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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
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Bacterial infection including dermatophilosis
Dermatophytosis
Pemphigus foliaceus, SLE
Drug eruption
Cutaneous lymphoma
History | Signs | Differentials | Tests | Therapy | Notes
Tests - 1
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Skin scrapings
Blood tests: routine haematological and
biochemical screens
Fungal culture of scale and hairs
Multiple skin biopsy samples
History | Signs | Differentials | Tests | Therapy | Notes
Tests - 2
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Scrapings did not reveal ectoparasites or fungal
structures
Scales/crusts were emulsified and smears
examined for bacteria including Dermatophilus; no
significant findings
Haematology: marked leukocytosis (35.1 x
103/mm3) with neutrophilia and lymphocytosis,
slightly reduced RBC count.
Blood biochemistry: raised total protein,
hyperglobulinaemia, raised ALP and CK
History | Signs | Differentials | Tests | Therapy | Notes
What now?
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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
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No immediate action taken
No parasites or evidence of dermatophytes
demonstrated in scrapings
Smears failed to reveal significant bacteria
The leucocytosis (neutrophilia + lymphocytosis)
were suggestive of possible bacterial infection but
the blood biochemistry results were not diagnostic
Antibacterial therapy might have been instituted
but was inhibited by cost and because no
significant deterioration was expected before
biopsy results were available
History | Signs | Differentials | Tests | Therapy | Notes
Results
Histopathology
An interface dermatitis
pattern predominated,
possible indicating lupus or
a drug eruption
History | Signs | Differentials | Tests | Therapy | Notes
What is your
diagnosis?
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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
Further steps
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Consultation with the pathologist
The histological picture was not clear and the
pathologist suggested a second opinion supported
by immunohistochemical studies
History | Signs | Differentials | Tests | Therapy | Notes
Results
Histopathology
Another view of the
histopathology showing
lichenoid infiltration and
microabscess formation with
predominantly mononuclear
cells
History | Signs | Differentials | Tests | Therapy | Notes
Diagnosis
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Subsequent immunohistochemical studies showed
a strong reaction to CD-3 of infiltrating cells.
A diagnosis of epidermotropic lymphoma was
made
History | Signs | Differentials | Tests | Therapy | Notes
How would you deal
with this case?
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What is your prognosis?
How will you advise the owner?
What treatment would you consider?
History | Signs | Differentials | Tests | Therapy | Notes
Prognosis
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Prognosis is grave
• Disease is fatal
• Steroids and cytotoxic drugs are unlikely to be
helpful
• Euthanasia was carried out
History | Signs | Differentials | Tests | Therapy
Therapy | Notes
Review
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History | Signs | Differentials | Tests | Therapy | Notes