Crusting and ulceration in a crossbred dog Author: David GrantEditor: David Lloyd © European Society of Veterinary Dermatology

History | Signs | Differentials | Tests | Therapy | Notes Click to reveal the text on this screen Click the forward arrow to jump to the next screen History – 1 History 2-year-old entire male crossbred dog Weight 10 kg Initial ‘sores’ on lip, nose, scrotum developed over ‘a week or two’ Dog otherwise healthy. No pruritus.

History | Signs | Differentials | Tests | Therapy | Notes History - 2 History Treated with antibiotics and steroids 2 weeks later no response Dog now shows malaise, anorexia

History | Signs | Differentials | Tests | Therapy | Notes History - 3 No other history of dermatological disease There is a healthy canary but no other animals in the house Owners have no lesions No history of contact with or ingestion of irritant substances Rectal temperature 103 o C Depressed demeanour History

History | Signs | Differentials | Tests | Therapy | Notes Clinical signs - 1 Signs Crusting, mucopurulent discharges and ulceration are apparent at various sites Ulceration and discharge from the lids of the left eye Ulceration of the lip margins

History | Signs | Differentials | Tests | Therapy | Notes Clinical signs - 2 Signs Crusting, exudation and pustular lesions affecting the footpads

History | Signs | Differentials | Tests | Therapy | Notes How would you approach 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 a definitive diagnosis Signs

History | Signs | Differentials | Tests | Therapy | Notes Differential diagnoses Differentials Bullous pemphigoid, drug eruption, SLE, mococutaneous candidiasis Also ulcerative stomatitis, neoplasia, dermatophytosis, secondary pyoderma

History | Signs | Differentials | Tests | Therapy | Notes Tests - 1 Tests Skin scrapings, Nikolsky test Blood tests: routine haematology and biochemical screens Fungal culture of crusts and exudate Multiple biopsy samples from intact vesicles/pustules and edges of ulcers

History | Signs | Differentials | Tests | Therapy | Notes Tests - 2 Scrapings from crusted areas did not reveal ectoparasites or fungal structures The Nikolsky sign was not elicited Smears of exudate stained with Giemsa showed coccoid and rod-shaped bacteria in moderate numbers, neutrophils, and some acanthocytes No satisfactory smears were obtained from intact pustules or vesicles Tests

History | Signs | Differentials | Tests | Therapy | Notes What now? Tests What treatment should you now institute, if any, whilst waiting for the fungal cultures and biopsy results? What are now your principle differential diagnoses? Are there any other samples you would collect

History | Signs | Differentials | Tests | Therapy | Notes Tests - 3 Tests Blood screens showed a slight neutrophilia but were otherwise unremarkable Fungal cultures were negative for dermatophytes or yeasts Histopathological examination of biopsy samples revealed an intra- and sub-epidermal vesicular dermatitis

History | Signs | Differentials | Tests | Therapy | Notes Tests - 4 Tests Acanthosis with suprabasilar and some subepidermal clefts. A lichenoid band of inflammatory cells and some pigmentary incontinence in upper dermis and around follicles Histopathology

History | Signs | Differentials | Tests | Therapy | Notes What is your diagnosis? Do the investigations permit a definitive diagnosis? Are there any additional investigations which you think may need to be done? Tests

History | Signs | Differentials | Tests | Therapy | Notes Pemphigus vulgaris Lesion type, location and histopathology are consistent No history of previous drug therapy and histopathology not consistent with EM and TEN Vesicles or bullae are subepidermal in bullous pemphigoid Fungal culture was negative Diagnosis Tests

History | Signs | Differentials | Tests | Therapy | Notes How would you deal with this case? What is your prognosis? How will you advise the owner? What treatment would you consider? Tests

History | Signs | Differentials | Tests | Therapy | Notes Prognosis Prognosis is guarded Disease can be fatal if not successfully treated Dogs may not tolerate steroids and other immunomodulatory drugs Lifelong therapy is necessary Tests

History | Signs | Differentials | Tests | Therapy | Notes Therapy Induction therapy - first 3 weeks Methylprednisolone orally, 5 mg/kg daily Azathioprine orally, 2.2 mg/kg every other day

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 Notes

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