Generalised scaling ina male donkey

Author: Mark Craig

Editor: David Lloyd

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History

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History

•10-year-old entire male donkey

•First signs

•Reduced appetite, weight loss, generalised scaling

•In progress over a 3-month period

•Treatment by referring vet

•Intramuscular penicillin/streptomycin daily for 10days

•No improvement

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Clinical signs - 1

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Signs

•Generalised exfoliative erythroderma

•Thin, depressed

•Rectal temperature, pulse rate, respiratory ratenormal

•No peripheral lymphadenopathy

•No oral lesions were present

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Clinical signs - 2

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Signs

•The donkey is thinand depressed

•There is poor coatwith generalisedscaling

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Clinical signs - 3

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Signs

Periocular scaling and greasymatted hair around the eye

Exfoliation and erythemaof the scrotum

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Clinical signs - 4

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Signs

Close up of scaling,

matting of coat and

underlying erythema

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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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Differentialdiagnoses

Differentials

•Bacterial infection including dermatophilosis

•Dermatophytosis

•Pemphigus foliaceus, SLE

•Drug eruption

•Cutaneous lymphoma

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Tests - 1

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Tests

•Skin scrapings

•Blood tests: routine haematological andbiochemical screens

•Fungal culture of scale and hairs

•Multiple skin biopsy samples

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Tests - 2

Tests

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•Scrapings did not reveal ectoparasites or fungalstructures

•Scales/crusts were emulsified and smearsexamined for bacteria including Dermatophilus; nosignificant findings

•Haematology: marked leukocytosis (35.1 x103/mm3) with neutrophilia and lymphocytosis,slightly reduced RBC count.

•Blood biochemistry: raised total protein,hyperglobulinaemia, raised ALP and CK

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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

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•No immediate action taken

•No parasites or evidence of dermatophytesdemonstrated in scrapings

•Smears failed to reveal significant bacteria

•The leucocytosis (neutrophilia + lymphocytosis)were suggestive of possible bacterial infection butthe blood biochemistry results were not diagnostic

•Antibacterial therapy might have been institutedbut was inhibited by cost and because nosignificant deterioration was expected beforebiopsy results were available

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Results

Tests

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An interface dermatitis

pattern predominated,

possible indicating lupus or

a drug eruption

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Histopathology

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What is yourdiagnosis?

Tests

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•Do the investigations permit a definitive diagnosis?

•Are there any additional investigations which youthink may need to be done

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Further steps

Tests

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•Consultation with the pathologist

•The histological picture was not clear and thepathologist suggested a second opinion supportedby immunohistochemical studies

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Results

Tests

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Another view of the

histopathology showing

lichenoid infiltration and

microabscess formation with

predominantly mononuclear

cells

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Histopathology

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Diagnosis

Tests

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•Subsequent immunohistochemical studies showeda strong reaction to CD-3 of infiltrating cells.

•A diagnosis of epidermotropic lymphoma wasmade

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How would you dealwith this case?

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Therapy

•What is your prognosis?

•How will you advise the owner?

•What treatment would you consider?

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Prognosis

Therapy

•Prognosis is grave

•Disease is fatal

•Steroids and cytotoxic drugs are unlikely to behelpful

•Euthanasia was carried out

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Review

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Notes

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