Generalised scaling ina male donkey
Author: Mark Craig
Editor: David Lloyd
  © European Society of Veterinary Dermatology
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
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History
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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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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Clinical signs - 1
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Generalised exfoliative erythroderma
Thin, depressed
Rectal temperature, pulse rate, respiratory ratenormal
No peripheral lymphadenopathy
No oral lesions were present
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Clinical signs - 2
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The donkey is thinand depressed
There is poor coatwith generalisedscaling
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Clinical signs - 3
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Periocular scaling and greasymatted hair around the eye
Exfoliation and erythemaof the scrotum
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Clinical signs - 4
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Close up of scaling,
matting of coat and
underlying erythema
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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
Differentialdiagnoses
Bacterial infection including dermatophilosis
Dermatophytosis
Pemphigus foliaceus, SLE
Drug eruption
Cutaneous lymphoma
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Tests - 1
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Skin scrapings
Blood tests: routine haematological andbiochemical screens
Fungal culture of scale and hairs
Multiple skin biopsy samples
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Tests - 2
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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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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
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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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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Results
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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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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
What is yourdiagnosis?
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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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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Further steps
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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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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Results
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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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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Diagnosis
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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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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
Prognosis
Prognosis is grave
Disease is fatal
Steroids and cytotoxic drugs are unlikely to behelpful
Euthanasia was carried out
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Review
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