Crusting and ulceration in a crossbred dog

Crusting and ulcerationin a crossbred dog

Author: David Grant

Editor: David Lloyd

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History – 1

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History

•2-year-old entire male crossbred dog

•Weight 10 kg

•Initial ‘sores’ on lip, nose, scrotum developed over ‘aweek or two’

•Dog otherwise healthy. No pruritus.

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History - 2

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History

•Treated with antibiotics and steroids

•2 weeks later no response

•Dog now shows malaise, anorexia

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History - 3

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•No other history of dermatological disease

•There is a healthy canary but no other animals in thehouse

•Owners have no lesions

•No history of contact with or ingestion of irritantsubstances

•Rectal temperature 103oC

•Depressed demeanour

History

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Clinical signs - 1

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Signs

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Crusting, mucopurulent discharges and ulceration areapparent at various sites

Ulceration and dischargefrom the lids of the left eye

Ulceration of the lip margins

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Clinical signs - 2

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Signs

Crusting, exudation andpustular lesions affectingthe footpads

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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 adefinitive diagnosis

Signs

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Differentialdiagnoses

Differentials

•Bullous pemphigoid, drug eruption, SLE,mococutaneous candidiasis

•Also ulcerative stomatitis, neoplasia,dermatophytosis, secondary pyoderma

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Tests - 1

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Tests

•Skin scrapings, Nikolsky test

•Blood tests: routine haematology andbiochemical screens

•Fungal culture of crusts and exudate

•Multiple biopsy samples from intactvesicles/pustules and edges of ulcers

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Tests - 2

•Scrapings from crusted areas did not revealectoparasites or fungal structures

•The Nikolsky sign was not elicited

•Smears of exudate stained with Giemsa showedcoccoid and rod-shaped bacteria in moderatenumbers, neutrophils, and some acanthocytes

•No satisfactory smears were obtained from intactpustules or vesicles

Tests

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What now?

Tests

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•What treatment should you now institute, if any,whilst waiting for the fungal cultures and biopsyresults?

•What are now your principle differentialdiagnoses?

•Are there any other samples you would collect

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Tests - 3

Tests

•Blood screens showed a slight neutrophilia but wereotherwise unremarkable

•Fungal cultures were negative for dermatophytes oryeasts

•Histopathological examination of biopsy samplesrevealed an intra- and sub-epidermal vesiculardermatitis

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Tests - 4

Tests

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Acanthosis with suprabasilarand some subepidermalclefts. A lichenoid band ofinflammatory cells and somepigmentary incontinence inupper dermis and aroundfollicles

Histopathology

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What is yourdiagnosis?

•Do the investigations permit a definitive diagnosis?

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

Tests

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•Pemphigus vulgaris

•Lesion type, location and histopathology are consistent

•No history of previous drug therapy and histopathologynot consistent with EM and TEN

•Vesicles or bullae are subepidermal in bullouspemphigoid

•Fungal culture was negative

Diagnosis

Tests

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How would you dealwith this case?

•What is your prognosis?

•How will you advise the owner?

•What treatment would you consider?

Tests

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Prognosis

•Prognosis is guarded

•Disease can be fatal if not successfully treated

•Dogs may not tolerate steroids and otherimmunomodulatory drugs

•Lifelong therapy is necessary

Tests

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Therapy

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Therapy

•Induction therapy - first 3 weeks

•Methylprednisolone orally, 5 mg/kg daily

•Azathioprine orally, 2.2 mg/kg every other day

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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

Notes

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Review

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Notes

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