Category: Articles

Case presentation:

A twelve year old female, entire Labrador Retriever, presented with skin ulcers over the low lid region of the eyes, feet, face, back and legs. According to the owners the animal has become more lethargic, less active on walks and not as playful in the last twelve months.They attributed this to the age of the animal. At referring vet took a blood sample to do hematology and biochemistry, which did not show abnormalities. They treated the animal with amoxicillin with clavulanic acid.

Diagnostic approach.

• * microscopic examination- Negative for ectoparasites
• * impression smear- Colonized neutrophils with cocci bacteria.
• * microbiology- Staphylococcus aureus pure culture sensitive to amoxicillin with clavulanic acid* Level of TT4 in blood was Low <6 nmol/L>

Treatment:

• * Local therapy shampoo containing benzoyl peroxide. Name(Peroxyderm)
• * Systemic antibiotic – amoxicillin with clavulanic acid.
• * Levothyroxine 0.2mg / kg once daily.

Follow up:

Two weeks after starting treatment, the owners reported that Cleo feels much better and has increased her exercise activity and she is playful. There were fewer skin ulcers predominantly over the front legs and around the eyes but ulcers were superficial. The follow up examination showed a shiny healthy coat, with few skin lesions on the legs.

The only thing that worried the owners was that Cleo’s neck had turned green. Blood was taken to test her TT4 levels and to determine whether we need to change the dose of levothyroxine.

I believe the reason for the green coat is probably heavily chlorinated water and frequent bathing at the beginning of therapy. (This is not proven by research).

The skin ulcers were much larger and bleeding, and her lymph nodes were double the size. Ulcers on her face were approximately 5cm in diameter. An abdominal ultrasound was performed and showed enlarged mesenteric lymph nodes. Fine needle aspirates of the enlarged lymph nodes and punch biopsies of the skin were taken at this time. The result of the FNA revealed- The cell population is homogeneus excibiting several blastic cells, with granular cromatin and inconspicuous cytoplasm. Several mitotic figures are also present. Random, plasma cells are observed accompaniating the neoplastic lymphoblasts. The result of the skin punch biopsy revealed changes characteristic of Sebaceous carcinoma. Based on the new evidence and the results, chemotherapy was recommended but the owners declined. They agreed to a less aggressive therapy with oral prednisolone 2mg/kg , levothyroxine 0.3 mg/kg and gabanevral 10mg/kg and local therapy with prednisolone. Six months later, Cleo’s disease was stable, with significantly smaller lymph nodes and skin lesions.

Dr Iva Nikolova
Veterinary Clinic Dobro Hrumvane
Sofia, Bulgaria

Introduction

Cutaneous asthenia has also been called Ehlers-Danlos syndrome (EDS), Dermal fragility syndrome, Dominant collagen dysplasia and Dermatosparaxis. EDS is a group of inherited connective tissue diseases ,characterized by defects in collagen production. This results in a variety of clinical signs including loose, hyperextensible, fragile skin, joint laxity and other connective tissue dysfunctions. Clinical signs include fragile skin from the time of birth, wounds that heal with thin scars, delayed wound healing, pendulous skin, hematoma and hygroma formation.

The case:

Lucko, 7-month-old shorthair male mix breed cat, was represented to the clinic with uveitis, alopecia and multiple skin ulcerative wounds, located in the regions of the dorsum, thorax and head. He was treated for few months with antibiotics, ointments and corticosteroids with no success. The skin of the cat was extremely extensible and very fragile. It was very easy for the skin to be torn but with no bleeding at all. The cat had to be handle with gentle touch and care.

The diagnostic work-up included a complete blood count, blood serum biochemistry panel and urinalysis to rule out any internal disease associated with these skin lesions. CBC showed mild leucocytosis (white blood cell count: 19.5 x 10^9, reference range: 5.0 x 10^9 –18.9 x 10^9). In biochemistry analisys the changes were CK – 225 U/L (reference range: 17.00 – 150.20 U/L) and LDH – 427 U/L (reference range: 35.10 – 224.90 U/L).

The rapid test of Feline Immunodeficiency Virus and Feline Leukemia Virus (IDEX FIV/FeLV) were found to be negative. Feline Herpes Virus PCR – negative. Dermafyt KRUUSE test – negative. Microbiology of skin lesions – negative. The low-dose dexamethasone suppression test – negative for Cushing disease.

During the long-lasting treatment all the wounds healed well and Lucko was sent home. Few days later he was brought again with new skin lacerations.

Punch biopsy of the skin was performed together with dr Rares Capitan and sent for histological investigation in Romania. The histopathologic findings were compatible with Feline Cutaneous Asthenia.

Discussion:

Feline Cutaneous Asthenia is a rare, inherited disorder of collagen production in cats. There is no cure, but consistent management can allow affected cats to have long life. Owners should be trained to handle the affected cat with gentleness and to avoid traumas.

Medical history

Lora, 4-year-old female cross breed dog, was presented for large area of erythema and pustules on the left flank and squamosis zones on the dorsum. There was a mild pruritus. This dog was diagnosed with erhlichiosis and anaplasmosis one month ago and she was treated with injectable dexamethasone and oral doxycycline by her veterinarian. The general condition during the first consultation a month ago was poor with lethargy, icterus and anorexia. 7 days before the presentation the general condition of the dog was much better but skin lesions started to appear. The dog has never had any skin problems before.

Clinical examination

Clinical examination revealed small areas on the dorsum with squamosis (fig.1) and alopecia, some areas with alopecia, erythema, comedones and crusts (fig. 2). The most prominent lesion was a large area with erythema, papules, pustules and crusts on the left flank (fig.3 and fig 4).

Diagnostic

Skin scrapings were positive with Demodex canis in all microscopic fields. There were more than 100 Demodex spp visible on skin scraping slide. Demodex canis was visible on the scotch tests as well (fig.5a and fig.5b). Microscopic observation of impression smears revealed pyogranulomatous inflammation (degenerated neutrophils and macrophages)(fig.6) with figures of phagocytosis (fig.7) and Demodex spp (fig.8) as well. The diagnosis is Demodicosis, probably secondary to treatment with corticosteroids, and secondary deep pyoderma.

Treatment The acaricidal therapy was with oral ivermectin. The ivermectin administation started with gradual dose increase from 0,05 mg/kg on day 1,0,1 mg/kg on day 2, 0,15 mg/kg on day 3, 0,2 mg/kg on day 4, 0,3 mg/kg on day 5, 0,4 mg/kg on day 6 and 0,5 mg/kg on day 7 and keeping this dose for 30 days until the first scraping control. Because of the presence of infection antibiotic treatment with amoxicillin-clavulonic acid was started (15 mg/kg BID for 30 days until first control).Topical antimicrobial therapy with benzoyl peroxide (Peroxyderm, Vetoquinol) every 3 days was also recommended. All kind of steroids was stopped.

Evolution The dogs supported very well all components of the treatment. 35 days after the first dose of ivermectin, skin scrapings were performed and there were 5 demodex ssp seen in total. The clinical lesions were gone at least 7 days ago, so the antibiotic was stopped, the shampooing was diminished in frequency (once weekly), the ivermectin was continued at 0,5 mg/kg for 30 more days. 65 days after the initial presentation, skin scrapings were performed and they stayed positive with 4 Demodex found on the slide. The ivermectin was continued for 30 more days. Approximately 95 days after the initial examination, skin scrapings were negative for the first time so the ivermectin was continued for 30 more days. 125 days after the initial presentation the skin scrapings were negative for second time. Complete resolution of the previous clinical lesions was seen in the first 30 days of the treatment, but the treatment stopped after 2 negative skin scrapings control. Pictures are taken 11 months after the first dermatological consultation (Fig. 9). There wasn`t any relapse for 7 months after the last ivermectin dose.

Discussion When the dogs first experience the disease at 4 years of age or older, they have true adult-onset demodicosis. This form of demodicosis is rare. When it occurs, different underlying conditions are recongnized. Such disorders are hypothyroidism, hyperadrenocorticism, leishmaniasis, malignant neoplasia, immunosuppressive treatments for cancer or autoimmune diseases. In more than 50% of cases, no underlying disease can be proven at the time of diagnosis demodicosis. In this case the precious corticosteroids treatment, the complete recovery and the lack of relapse for more than 6 months after the last ivermectin dose indicate that the main possible reason is the corticosteroid treatment.

References:
Small Animal Dermatology, 7th edition, Miller, Griffin, Campbell, 2013

Case presentation:

Rabbit nine months old , female  entire.She was presented  to the clinic with a history of progressive hair loss over the last two months. The rabbit came as a second opinion from another practice where she was treated for mange mites for a month with Doramectin and  a month treatment for dermatophytes without result of both treatments.
A clinical examination found:
Generalised alopecia, yellow crusty skin,pododermatitis over the pelvic limbs and  abnormal skin elasticity.

 Diagnostic approach.

*microscopic examination- Negative for ectoparasites *Punch biopsy-  There is  diffuse thickening of the  epidermis characterized by laminated stratum corneum with disproportionate  thickness than the underlying nucleated epidermis. Focal parakeratosis is also present. The epidermis is mildly to moderately achantotic. The follicular infundibulum is greatly distended by keratin. The granular layer of the epidermis exhibits different sizes of keratohyalin granules (hypergranulosis). Superficial dermis  lacks  follicular and adnexal structures. Few intact sebaceous glands are present. There is  no evidence of  neoplastic cells, parasitic/mycotic/fungal or bacterial elements in the examinated sections. The histological appearace is consistent with non-epidermolytic ichthyosis.

Treatment:

Treatment was undertaken to support body hydration, using megaderm( omega three  and six fatty acids,linolenic acid,GLA,EPA,DHA )in order to  strengthen the skin structure.  pain medication(meloxicam 0.2mg/kg ), and antibiotic therapy(Procaine penicillin 150,000 IU per mL. Benzathine penicillin 150,000 IU per mL. ) to control the bacterial infection of the feet. There was an option for treatment microneedle therapy, but the sample for histopathological study did not showed hair follicles.

After one month of therapy the  rabbits skin had  significantly improved.  However pododermatitis had worsened and abscesses had formed  over the limbs. Due to failure of antibiotic  therapy and deteriorationof pododermatitis, the decision was to euthanase the rabbit.

Discussion

Ichthyosis is a inherited genetic disorder that occurs both in humans and in animals characterized by diffuse  keratinization  of the surface layer of the skin.  The disease develops as a result of gene mutation that is passed from generation to generation.
Ichthyosis studies are more for dogs and cats, and not so much about rabbits. There is not much information regarding the classification of rabbit Ichthyosis and details of treatment or maintenance therapy.
Affected BreedsThe West Highland White Terrier and the Golden Retriever are the breeds most predisposed to this disease.