Transcript Case of the Month - Ross Bond

Seborrhoea and otitis
in a springer spaniel
Author: Ewan Ferguson
Editor: David Lloyd
© European Society of Veterinary Dermatology
History and presenting
clinical signs - 1
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Entire 8-year-old male Welsh springer spaniel
Weight 36 kg
Non-seasonal dermatosis of 2 years duration
Moderate erythema and severe lichenification of
pinnae, periaural skin, ventral neck, tail and
abdomen. Moderate hyperpigmentation present
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History | Signs | Approach | Tests | Treatment | Notes
History and presenting
clinical signs - 2
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Generalised seborrhoea, strong odour and dull brittle
coat. Purulent discharge from ears. Affected areas
severely pruritic
Thirst and appetite unchanged. Alert but less active
than littermate
Minimal response to appropriate doses of systemic
antibiotics and glucocorticoids
History | Signs | Approach | Tests | Treatment | Notes
Clinical findings on
first presentation - 1
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History | Signs
Signs | Approach | Tests | Treatment | Notes
Clinical findings on
first presentation - 2
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History | Signs
Signs | Approach | Tests | Treatment | 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
a definitive
definitive
diagnosis
diagnosis
History | Signs | Approach | Tests | Treatment | Notes
Case
investigation - 1
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Next steps
• A thorough physical examination is mandatory
• Comparison with littermate would be valuable
Principle differential diagnoses
• Primary problems: hypothyroidism, demodicosis,
ectoparasitism, food intolerance, atopy
• Secondary problems: Malassezia dermatitis,
pyoderma, bacterial otitis
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History | Signs | Approach | Tests | Treatment | Notes
Case
investigation - 2
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Samples
• Deep and superficial skin scrapings, tape strippings
and impression smears for cytology, biochemistry and
haematology panels, swabs from ears for bacteriology
Tests
• TSH response test, elimination diet
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History | Signs | Approach | Tests | Treatment | Notes
Test results - 1
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Comparison with littermate
• Obese, less active
Skin scrapings
• No ectoparasites or fungal elements
Tape strippings
• Many Malassezia yeasts in all samples
Aural swabs
• Smears show yeasts and Gram-negative rods
• Pseudomonas spp. on culture
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History | Signs | Approach | Tests | Treatment | Notes
Clinical appearance comparison with littermate
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History | Signs | Approach | Tests | Treatment | Notes
Test results - 2
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Blood tests
• Mild normochromic, normocytic anaemia
• Fasted serum cholesterol = 8.2 mmol/l
Elimination diet
• No change in clinical signs
TSH response test (total plasma T4)
• Basal = 24.5 nmol/l
• 6 hrs post TSH = 29.3 nmol/l
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History | Signs | Approach | Tests | Treatment | Notes
What is your
diagnosis?
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What is your principle diagnosis?
List any additional problems which you think may need
treatment
Are there any other possibilities which should be
considered at this stage?
History | Signs | Approach | Tests | Treatment | Notes
Diagnosis
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Hypothyroidism with secondary Malassezia dermatitis
and otitis with Pseudomonas sp. infection
It would probably be difficult to accurately assess any
concurrent disease until these problems have been
controlled
History | Signs | Approach | Tests | Treatment | Notes
How would you deal
with this case?
List the steps you would now take to treat:
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The hypothyroidism
The Malassezia dermatitis
The Pseudomonas otitis
History | Signs | Approach | Tests | Treatment
Treatment | Notes
Treatment - 1
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Hypothyroidism
• Oral levothyroxine given at 10-20 µg/kg bid
• Monitor 4 hour post-pill serum total T4 concentrations
after 12 weeks
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History | Signs | Approach | Tests | Treatment
Treatment | Notes
Treatment - 2
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Malassezia dermatitis
• Whole body baths with 1% w/v selenium sulphide
shampoo followed by 2 mg/ml enilconazole rinse.
Treatment repeated every 4 days
• If response was poor, systemic ketoconazole at 10
mg/kg bid might be considered. Not first choice of
therapy in this case, in view of concurrent
endocrinopathy.
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History | Signs | Approach | Tests | Treatment
Treatment | Notes
Treatment - 3
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Pseudomonas otitis
• Flush canals under general anaesthetic to remove
debris and inspect tympanic membranes
• Bulla radiographs if otitis media suspected
• In this case, 0.02% chlorhexidine washes followed
by Tris-EDTA drops and 0.3% gentamicin drops
were used
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History | Signs | Approach | Tests | Treatment
Treatment | Notes
Response to treatment
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Treated with 400 µg/kg bid. Washes applied once
weekly
Weight reduced from 36 kg to 31 kg after 6 months.
Post-pill TT4 32 nmol/l
Good hair regrowth in all affected areas. Some
seborrhoea still present. Odour, lichenification,
erythema and hyperpigmentation greatly reduced
Minimal pruritus. Otitis now resolved
History | Signs | Approach | Tests | Treatment | Notes
Notes
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History | Signs | Approach | Tests | Treatment | Notes
Notes