Crusting and exudation in a Welsh stallion pony

Crusting and exudationin a Welsh stallion pony

Author: Mark Craig

Editor: David Lloyd

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History -1

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History

•10-year-old Welsh pony stallion

•Weight 300 kg

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History -2

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History

•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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Clinical signs - 1

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Signs

The horse was thin and there was generalisedcrusting with diffuse alopecia

No peripherallymphadenopathywas detected

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Clinical signs - 2

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Signs

Close-up views of alopecic and crusted areas

Clipped area on thewithers

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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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Test - 1

Differentials

•Principle differential diagnoses

•Bacterial folliculitis, dermatophilosis, dermatophytosis

•Ectoparasitic infestation

•Pemphigus complex, SLE, drug eruption

•Allergy

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Tests - 2

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Tests

•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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Results

Tests

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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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What now?

Tests

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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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Initial therapy

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Therapy

•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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What is yourdiagnosis?

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Therapy

•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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Further tests

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Therapy

•A superficial pustulardermatitis was present

•The pustules containedmany neutrophils &acanthocytes but nomicro-organisms

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Histopathology

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Diagnosis

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Therapy

•Pemphigus foliaceus

•Lesion type and histopathology are consistent

•No history of previous drug therapy

•Fungal culture was negative

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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?

Therapy

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Response to therapy - 1

Notes

•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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Response to therapy - 2

Notes

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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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Prognosis

Notes

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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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Review

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Notes

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