Transcript Case of the Month

11-year old Cavalier King Charles
Author: Ross Bond
Editor: David Lloyd
© European Society of Veterinary Dermatology
History and
presenting clinical signs - 1
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11 year-old Cavalier King Charles spaniel
Entire male
Progressive skin disease of 3 weeks duration
Owner reported reluctance to walk and
interdigital dermatitis
Now “blisters” on perineum and scrotum
History and
presenting clinical signs – 2
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Dog reportedly depressed
Thirst and appetite considered normal
Skin lesions progressively more severe
Moderate pedal and perineal pruritus
Clinical findings on referral
Peri-oral
crusts and
fissures
Clinical findings on referral
Linear preputial lesion;
erythema; erosion,
crust
Clinical findings on referral
Interdigital erythema
and exudation
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.
Case
investigation
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Principle differential diagnoses
• Metabolic epidermal necrosis
(superficial necrolytic dermatitis)
• Pemphigus foliaceus
Diagnostic Tests
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Skin scrapings
Skin biopsy
Haematological and biochemical profiles
Urinalysis
Results
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No evidence of parasites and fungal elements
on microscopy
Elevated alkaline phosphatase, alanine
aminotransferase, glucose, cholesterol
Mild lymphopenia and eosinopenia
Urinalysis unremarkable
Results
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Skin biopsy specimens showed
• Compact diffuse parakeratosis and
hydropic degeneration of the upper
epidermis
• Mild acanthosis and sparse mononuclear
cell infiltrate in the upper dermis
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?
Diagnosis
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Metabolic epidermal necrosis
• Historical and clinical features
suggestive, supported by
histopathology
• Laboratory tests support a
metabolic disorder
Further tests
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Post-prandial bile acids were elevated,
consistent with hepatobiliary
dysfunction
Abdominal ultrasonography showed
diffuse hepatic disease
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?
Prognosis
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PROGNOSIS IS POOR
• Many cases are difficult to
manage and require euthanasia,
either because of the severe skin
disease or due to hepatic disease
or pancreatic neoplasia
Therapy
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Symptomatic therapy only
Systemic and / or topical antibacterial therapy
Nutritional supplementation with high protein
diets helpful in some cases
Glucocorticoids generally contra-indicated
owing to the metabolic disease
Specific therapy for hepatic or pancreatic
disease is ideal but seldom possible
Comment
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Most dogs have associated hepatic disease
(vacuolar alteration or cirrhosis); a few have
pancreatic glucagonomas
Some dogs become diabetic
The cause of the hepatic and skin disease is
unknown
Skin lesions may reflect hypo-aminoacidemia
(present in this case)
Comment
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The periorificial lesions plus footpad
hyperkeratosis are the usual findings
Often confused with autoimmune diseases
Ultrasound may allow visualisation of
pancreatic neoplasia or metastases in rare
cases, and distinguish from liver disease
Bile acid assays useful for assessment of
hepatic function
Review
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