crusting and ulceration in a crossbred dog author: david granteditor: david lloyd © european...

Crusting and ulceration in a crossbred dog

Author: David GrantAuthor: David Grant Editor: David LloydEditor: David Lloyd

© European Society of Veterinary Dermatology © European Society of Veterinary Dermatology


History - 2

HistoryHistory

• Treated with antibiotics and steroids

• 2 weeks later no response

• Dog now shows malaise, anorexia


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 103oC

• Depressed demeanour

HistoryHistory


Clinical signs - 1

SignsSigns

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


Clinical signs - 2

SignsSigns

Crusting, exudation and pustular lesions affecting the footpads


How would youapproach 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

SignsSigns


Differential diagnoses

DifferentialsDifferentials

• Bullous pemphigoid, drug eruption, SLE, mococutaneous candidiasis

• Also ulcerative stomatitis, neoplasia, dermatophytosis, secondary pyoderma


Tests - 1

TestsTests

• 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


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

TestsTests


What now?

TestsTests

• 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


Tests - 3

TestsTests

• 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


Tests - 4

TestsTests

Acanthosis with suprabasilar and some subepidermal clefts. A lichenoid band of inflammatory cells and some pigmentary incontinence in upper dermis and around follicles

Histopathology


What is yourdiagnosis?

• Do the investigations permit a definitive diagnosis?

• Are there any additional investigations which you think may need to be done?

TestsTests


• 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

Diagnosis

TestsTests


How would you deal with this case?

• What is your prognosis?

• How will you advise the owner?

• What treatment would you consider?

TestsTests


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

TestsTests


Therapy

TherapyTherapy

• Induction therapy - first 3 weeks• Methylprednisolone orally, 5 mg/kg daily• Azathioprine orally, 2.2 mg/kg every other day


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

NotesNotes


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NotesNotes

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crusting and ulceration in a crossbred dog author: david granteditor: david lloyd © european...

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