Transcript Case of the Month - Ross Bond

Scaling and crusting and otitis
in a springer spaniel
Author: Ewan Ferguson
Editor: David Lloyd
© European Society of Veterinary Dermatology
History - 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 | Differentials | Tests | Therapy | Notes
History - 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 | Differentials | Tests | Therapy | Notes
Clinical signs - 1
How would you
describe the lesions?
History | Signs | Differentials | Tests | Therapy | Notes
Clinical signs - 2
Alopecia,
lichenification,
erythema and crusting
affecting the groin and
the medial aspects of
both thighs
History | Signs | Differentials | Tests | Therapy | Notes
How would you
approach this case?
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How would you describe the skin lesions?
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
Case investigation
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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
History | Signs | Differentials
Differentials | Tests | Therapy | Notes
Tests - 1
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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
• Thyroid tests (total T4 and TSH), elimination diet
History | Signs | Differentials | Tests | Therapy | Notes
Tests - 2
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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, resistant to all commonly
used antibiotics except polymyxin B
History | Signs | Differentials | Tests | Therapy | Notes
Clinical appearance comparison with littermate
History | Signs | Differentials | Tests | Therapy | Notes
Tests - 3
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Blood tests
• Mild normochromic, normocytic anaemia
• Fasted serum cholesterol = 8.2 mmol/l
Elimination diet
• No change in clinical signs
Thyroid evaluation
• Total T4 = 10.4 nmol/l (range 13-52 nmol/l)
• TSH = 3.9 mol/l (normal <0.41 mol/l )
History | Signs | Differentials | Tests | Therapy | 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 | Differentials | Tests | Therapy | 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 | Differentials | Tests | Therapy | 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 | Differentials | Tests | Therapy | Notes
Therapy - 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
History | Signs | Differentials | Tests | Therapy | Notes
Therapy - 2
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Malassezia dermatitis
• Whole body baths with a 2% w/v miconazole and 2%
w/v chlorhexidine shampoo (Malaseb, Leo Animal
Health), 2-3 times weekly
History | Signs | Differentials | Tests | Therapy | Notes
Therapy - 3
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Pseudomonas otitis
• Flush both ear canals with saline until clean and
inspect tympanic membranes (under general
anaesthetic)
• Bulla radiographs if otitis media suspected
• In this case, both tympanic membranes were intact.
Both ears were to be cleaned twice daily with
EpiOtic (Virbac), followed by Otomax (ScheringPlough) twice daily one hour after cleaning.
History | Signs | Differentials | Tests | Therapy | Notes
Response to therapy
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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.
Otoscopy normal on both sides, no micro-organisms
on ear smear cytology
History | Signs | Differentials | Tests | Therapy | Notes
Notes
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Topical antimicrobial therapy was continued for
another two months
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Malaseb once or twice weekly
EpiOtic twice weekly
Thereafter, only thyroxine supplementation was
required. Clinical examination and post-pill tests
were performed every 6 months.
History | Signs | Differentials | Tests | Therapy | Notes
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History | Signs | Differentials | Tests | Therapy | Notes