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
History - 2 • • • Treated with antibiotics and steroids 2 weeks later no response Dog now shows malaise, anorexia History | Signs | Differentials | Tests | Therapy | Notes History
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 103 o. C Depressed demeanour History | Signs | Differentials | Tests | Therapy | Notes History
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 Signs
Clinical signs - 2 Crusting, exudation and pustular lesions affecting the footpads History | Signs | Differentials | Tests | Therapy | Notes Signs
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 Signs
Differential diagnoses • • Bullous pemphigoid, drug eruption, SLE, mococutaneous candidiasis Also ulcerative stomatitis, neoplasia, dermatophytosis, secondary pyoderma History | Signs | Differentials | Tests | Therapy | Notes Differentials
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
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 Tests
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
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
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 Tests
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 Tests
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 Tests
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 | Therapy | Notes Tests
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 Tests
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 Therapy
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
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