Crusting and ulcerationin a crossbred dog 
Author: David Grant
Editor: David Lloyd
  © European Society of Veterinary Dermatology
oct93
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
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History – 1
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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  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
History - 2
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Treated with antibiotics and steroids
2 weeks later no response
Dog now shows malaise, anorexia
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
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
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Clinical signs - 1
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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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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Clinical signs - 2
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Crusting, exudation andpustular lesions affectingthe footpads
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
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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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Differentialdiagnoses
Bullous pemphigoid, drug eruption, SLE,mococutaneous candidiasis
Also ulcerative stomatitis, neoplasia,dermatophytosis, secondary pyoderma
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Tests - 1
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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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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
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
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
What now?
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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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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Tests - 3
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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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Tests - 4
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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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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
What is yourdiagnosis?
Do the investigations permit a definitive diagnosis?
Are there any additional investigations which you thinkmay need to be done?
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
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
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
How would you dealwith this case?
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
Prognosis
Prognosis is guarded
Disease can be fatal if not successfully treated
Dogs may not tolerate steroids and otherimmunomodulatory drugs
Lifelong therapy is necessary
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Therapy
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Induction therapy - first 3 weeks
Methylprednisolone orally, 5 mg/kg daily
Azathioprine orally, 2.2 mg/kg every other day
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
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
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Review
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