Crusting and exudationin a Welsh stallion pony
Author: Mark Craig
Editor: David Lloyd
  © European Society of Veterinary Dermatology
jan94
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
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History -1
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10-year-old Welsh pony stallion
Weight 300 kg
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
History -2
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First signs developing over a 4-week period
Papules on flank and neck, pruritus
Generalised crusting and exudation
Swelling of all four legs accompanied by stiffness andlameness
Weight loss and lethargy
No treatment by the referring vet
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Clinical signs - 1
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The horse was thin and there was generalisedcrusting with diffuse alopecia
No peripherallymphadenopathywas detected
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Clinical signs - 2
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Close-up views of alopecic and crusted areas
Clipped area on thewithers
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
How would youapproach this case?
Signs
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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 adefinitive diagnosis
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Test - 1
Principle differential diagnoses
Bacterial folliculitis, dermatophilosis, dermatophytosis
Ectoparasitic infestation
Pemphigus complex, SLE, drug eruption
Allergy
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Tests - 2
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Tests
Blood tests: routine haematology and biochemicalscreens; ANA test
Multiple punch and excision biopsy samples fromcrusted and alopecic areas
Skin scrapings, crusts and hair pluckings formicroscopic examination, smears, bacterial andfungal culture
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Results
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Scrapings, crusts and hairs did not revealectoparasites or fungal structures; Dermatophiluswas not demonstrated on microscopicexamination
Haematological and biochemical profiles werewithin accepted limits.  The ANA test wasnegative
Histopathology revealed a superficial pustulardermatitis.  No micro-organisms were found in thelesions
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
What now?
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What treatment, if any, should you now institutewhilst waiting for the fungal cultures?
What are now your principle differentialdiagnoses?
Are there any other samples you would collect?
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Initial therapy
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Ectoparasitism and neoplasia were deemedunlikely
Autoimmune or immune-mediated diseaseseemed likely and the horse was deterioratinghence therapy was initiated
Prednisolone, 0.5 mg/kg daily; trimethoprim andsulphadiazine (Uniprim), 0.5 sachet daily
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
What is yourdiagnosis?
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What is your principle diagnosis?
Do the investigations permit a definitive diagnosis?
Are there any additional investigations which youthink may need to be done?
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Further tests
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A superficial pustulardermatitis was present
The pustules containedmany neutrophils &acanthocytes but nomicro-organisms
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Histopathology
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Diagnosis
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Pemphigus foliaceus
Lesion type and histopathology are consistent
No history of previous drug therapy
Fungal culture was negative
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
How would you dealwith this case?
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What is your prognosis?
How will you advise the owner?
What treatment would you consider?
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Response to therapy - 1
After 5 days the lesions were unchanged
The prednisolone dose was increased to 300 mgper day and there was a moderate improvementover a period of 10 days - decreased scaling andsome hair regrowth
Steroid therapy lapsed (owner’s choice) and thehorse’s condition remained stable over a two-month period but then again worsened
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Response to therapy - 2
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Prednisolone therapy at 300 mg twice daily (1mg/kg b.i.d.) was resumed.  Within 2 weeks alllesions had disappeared and after 1 month thehorse was reported to be in good condition
Attempts will be made to lower the dose over thecoming months
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Prognosis
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Prognosis is guarded
The disease may require potent immunosuppressivetherapy with significant side effects
It may not respond adequately
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Review
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