Degenerative Mucinotic Mural Folliculitis (DMMF) is a rare, poorly understood syndrome in cats, defined as an inflammatory reaction pattern. It is characterized by inflammation of the hair follicle, atrophy degeneration and mucin production. The inflammatory reaction, takes place on the follicle wall, primarily affecting the external sheath of the hair above the follicular isthmus. However it can also affect the infundibulum or the bulbar portion of the hair follicle.
Literature (incl. case studies) regarding feline DMMF is sparse. It can be briefly summarized as follows: All described cases are in middle aged to older cats, the majority of which are male, with no information on breed predisposition. The most characteristic features are: Alopecia of the face, head and neck and in a later stage affecting the body and limbs. Pruritus, if present, is mild to very intense. The diagnosis is confirmed by biopsy and subsequent histopathological examination.
Mila is an approximately 1,4 years old spayed female cat. She used to be a stray cat, until a lady, regularly
feeding her, noted dramatic changes to the cat’s fur. The lady temporarily adopted the cat and took her to several veterinarians. The lady provided shelter to about 20 other cats. According to the owner all cats were treated monthly with Broadline (Merial).
Picture 1.1, 1.2 Mila before the onset of her skin problem
First signs were: hypotrichosis of the face (pic. 2.1) and subsequent minor hypotrichosis of the distal parts of the limbs (pic. 2.2)
The cat’s skin condition gradually worsened. She showed progressive hypotrichosis, and alopecia, with severe pruritus. She was seen by a veterinarian and treated with Synulox (Zoetis) orally for 20 days, which reduced the inflammatory signs. Later she was seen by another veterinarian and underwent the following treatments (in a period of 3-4 months):
Pulse therapy (7 days of medication, 7 day break etc.) with oral itraconazole 5mg/kg q24h. Without good response.
Purina Pro Plan veterinary diets HA Hypoallergenic, for two months.
Ivermectin 0.3mg/kg q24h orally for 10 days.
According to the owner, the cat’s skin condition worsened. Described signs included: Pruritus, hypotrichosis, alopecia, skin hyperpigmentation and presence of scales and crusts.
The cat was admitted to our hospital for a second opinion. As as side note: Once admitted to our clinic, the lady signed the cat over to a local charity Redom.
The cat presented with the following signs:
- Symmetrical alopecia of the face and head. The skin had a thickened and swollen appearance.
- Severe pruritus (9/10 – 10/10)
- Hypotrichosis and alopecia of the entire body.
- Hyperpigmentation, scales and crusts covering the dorsum.
- Very passive and apathetic.
- According to the owner the animal is not feeling well, has an increased water intake and softer stools, with more frequent defecation than usual.
Differential diagnoses (several)
Feline atopic syndrome (allergies)
Feline sebaceous adenitis
Degenerative mucinous mural folliculitis
FIV / FeLV
Thymoma-associated exfoliative dermatitis in cats
The cat was hospitalized for further diagnostics and treatment was started, while waiting for the results of histopathology.
Results of clincial exam and diagnostic tests:
Skin scrape, hair plaque, tape strip: All negative for Demodex and Notoedres mites.
Tape strip cytology: Epithelial cells, but no neutrophils or Malassezia.
The ears have brown ear wax; Cytology – only epithelial cells, no Malassezia and no Otodectes cynotis.
CBC: WBC HH 58.24×109/L(5-19,5); NEU 25×109/L(2-12,5); LYM 16×109/ L; MONO 7,21 x109/L (0,15-1,7); EOS 8,58×109/L (0,1-0,79); BASO 0,13 x 109/L (0-0,1).
Blood Biochemistry: All parameters within normal range.
TT4= 18 nmol/l (10-80).
Urine: pH 7; PRO 30 mg/dl; GLU, KETO, UBG, BIL and BLOOD negative. No sediment.
Abdominal Ultrasound: Except for slightly enlarged inguinal lymph nodes, the other abdominal organs were unremarkable.
Chest radiographs: Bronchial pattern, possible cause could be lung worms. (Picture 4)
Fecal flotation: Negative
PCR (antigen) Assays: FCoV, FIV, FeLV, Toxoplasma gondii and Giardia ALL negative.
Skin biopsy: Histopathology results below.
Lymph node biopsy: Histopathology results below.
Picture 5 (5.1-5.4): The cat is licking and biting her legs and tail, as well as scratching her neck.
Intravenous fluids: Ringer’s lactate solution 10 ml/h for 5 days. Antibiotics: Ceftriaxone 30 mg/kg IV q12h and Enrofloxacin 5 mg/kg SC q24h for 14days each. Anti-parasitic: Fenbendazole 50 mg/kg PO q24h for 5 days. Antihistamine: Diphenhydramine 1,5 mg/kg SC q24h for 2 weeks. Continuation of Purina Pro Plan veterinary diets HA Hypoallergenic and supplementing this with 4 drops YuMEGA cat (omega-3, -6, -9 fatty acids) once daily. A single application of dexamethasone 0,25 mg/kg SC, resulted in a major reduction of the pruritus!
The CBC was repeated the next day, but did not show significant changes. However the CBC 48h after hospitalization did: WBC HH 44.8×109/L(5-19,5); NEU 19,5 x109/L (2-12,5); LYM 14,12 x109/L; MONO 1,96 x109/L (0,07-1,36); EOS 9,12 x109/L (0,06- 1,93); BASO 0,05 x109/L (0-0,1).
Clinically no evidence of polydipsia!
The charity agreed on taking biopsies (and subsequent histopathology) of the skin, spleen and enlarged lymph node.
Results – Histopathology
Spleen and inguinal lymphnode biopsy
(Dimitra Psalla, DVM, PhD)
Spleen: Multifocally white pulp is composed of atypical round cells with distinct cell borders, scant to moderate amphophilic cytoplasm, round to ovoid nuclei with finely stippled chromatin and one large basophilic nucleolus. There is moderate pleomorphism and mitoses average 1 per HPF. Multifocally red pulp is infiltrated by small numbers of neutrophils.
Inguinal lymphnode: Focal presence of atypical cells similar to those described above. Lymphnode is infiltrated by few neutrophils.
Diagnosis :Spleen and inguinal lymphnode: Infiltration by atypical round cells (accompanied by neutrophilic inflammation)
Comments: The diagnosis of lymphoma cannot be confirmed since the distribution of the atypical cells is limited on the white pulp and the pleomorphism is not high. This population could reflect a hyperplastic conditionas well.
Skin Biopsies – face, lateral body and dorsum
(Dimitra Psalla, DVM, PhD)
There is moderate irregular acanthosis that extends to follicular infundibula and is accompanied by mild spongiosis. Follicular isthmuses are severely infiltrated by the lymphocytes, histiocytes, neutrophils, and few eosinophils and multinucleated giant cells and the inflammatory infiltration is extending to the infundibulum. Parts of the follicular wall are widened due to accumulation of mucin (clear/basophilic spaces). Follicular atrophy is moderate to severe; normal anagen hair follicles are interspersed, particularly in less inflamed lesions. Moderate numbers of lymphocytes, histiocytes, neutrophils, and plasma cells surround hair follicles and infiltrate the superficial dermis. The histopathological features are similar in all the examined samples.
Diagnosis and Comments : The histopathological findings are compatible with the “Degenerative mucinotic mural folliculitis in cats”.
Picture 6 (6.1-6.3 pictures) Dimitra Psalla, DVM, PhD
Severely infiltrated Follicular isthmuses by the lymphocytes, histiocytes, neutrophils, and few eosinophils and multinucleated giant cells. Inflammatory infiltration is extending to the infundibulum. Accumulation of mucin. Follicular atrophy is moderate to severe. Moderate numbers of lymphocytes, histiocytes, neutrophils, and plasma cells surround hair follicles and infiltrate the superficial dermis.
Therapy continuation following the histopathology results:
The cat was started on oral prednisolone 3 mg/kg q24.Tapering off the prednisolone after 75% of the skin lesions had resolved and switching to cyclosporine, to avoid longer term adverse effects of corticosteroid treatment.
Picture 7(7.1-7.3 pictures) – One week after the start of prednisolone.
Supportive therapy included: Once weekly bathing with Clorexyderm ICF shampoo (4% chlorhexidine); Ectoparasite treatment with Stronghold plus (Zoetis) every 4 weeks; Purina Pro Plan veterinary diets HA Hypoallergenic and supplementing this with 4 drops YuMEGA cat once daily.
To stop the cat from reaching her skin and further self-mutilation, caused by the severe pruritus she was experiencing, she was dressed in a suit. She readily excepted the suit and wore it without any problem.
Picture 8(8.1-8.3 pictures) – Two weeks after the start of prednisolone.
Fur started regrowing on her head, body and legs.
There was a significant reduction in skin hyperpigmentation, scaling and crusting on the dorsum.
Gradually the pruritus decreased and the cat became more friendly, more active and was no longer apathetic.
After 3 weeks the prednisolone was tapered off gradually to an anti-inflammatory dose. (The oral prednisolone was decreased with 0.5 mg/kg every 5days, reaching 0,5 mg/kg q24h and finally after 5 days set on 0,5 mg/kg q48h).
Once the prednisolone dosage of 0,5 mg/kg q48h was reached, the cat was started on cyclosporine (suspension) 5mg/kg PO q24h simultaneously, for a duration of 10 days. Then the prednisolone was discontinued and the cyclosporine dosage increased to 7 mg/kg PO q24h.
Picture 9(9.1-9.5 pics.)Four weeks after the start of prednisolone.
Mila is much livelier and her fur is regrowing. However there are moments she is intensively licking herself, causing new skin lesions.
Picture 10(10.1-10.3 pics.)Two weeks after start of cyclosporin.
Mila while on cyclosporine – visibly improved. No more alopecia, no longer itchy and no new skin lesions.
Picture 11(11.1-11.6 pics.)Three weeks after start of cyclosporin.
Mila was feeling much better and was discharged after 12 weeks of inpatient care. She was now being cared for in a single-cat foster home. After discharging Mila she was monitored and followed up closely.
Mila was discharged and after two weeks came for her first check-up.
Picture 12 (12.1-12.4 pics.) Mila 2 weeks after discharging.
The cat progressed steadily, with normal fur regrowth on head, body, legs and tail. The skin of the dorsum was still very scaly.
The following supportive therapy was continued and slightly modified: Weekly washing with Clorexyderm 4% shampoo (ICF) , directly followed by washing with Allermyl (Virbac) shampoo. Topical treatment with Dermoscent Spot-on once weekly was added to the treatment protocol. Feeding Purina Pro Plan veterinary diets HA Hypoallergenic, but no longer supplementing with YuMEGA cat.
Picture 13(13.1-13.2 pics.) Mila in her foster home. Mila 8 weeks after discharging
The supportive therapy was continued and oral cyclosporine was reduced to 5 mg/kg q48h for another 2 months.
Her skin and coat were looking great and she was no longer itchy. She became active, friendly and very social.
Case Follow- up
Seven months after her last check-up Mila presented with dyspnoe. Diagnostics showed thoracic effusion and severe anemia. Thoracentesis was performed and she had several blood transfusions. However she didn’t improve. Feline Infectious Peritonitis was suspected. Eventually the decision was made to euthanize her.
I am particularly grateful for the cooperation with Dr. Rania Farmaki, Dp.ECVD, DVM and Dr. Dimitra Psalla, DVM, PhD. They provided me with invaluable advice and supported me throughout this difficult but interesting case. I would also like to thank the local charity Redom for their excellent care, trust and financial support. Finally, I wish to thank all my colleagues from the Central Veterinary Clinic in Sofia (Bulgaria) for their assistance.
Degenerative mucinotic mural folliculitis in cats- Gross TL, Olivry T, Vitale CB, Power HT. Vet Dermatol. 2001;12(5):279-8
Lymphocytic mural folliculitis and pancreatic carcinoma in a cat Remo Lobetti (Journal of Feline Medicine and Surgery 2015, 17 (6): 548-50)
Thymoma associated with exfoliative dermatitis in a cat. Jacqueline Vallim Jacobina Cavalcanti1, Mariana Pereira Moura1 and Fabio Oliveira Monteiro2 (Journal of Feline Medicine and Surgery 2014, Vol. 16(12) 1020– 1023)
First Case of Degenerative Mucinotic Mural Folliculitis in Brazil- Reginaldo Pereira de Sousa Filho, Veronica Machado Rolim, Keytyanne de Oliveira Sampaio, David Driemeier, Marina Gabriela Monteiro Carvalho Mori da Cunha, Fernanda Vieira Amorim da Costa
An anatomical classification of folliculitis-Gross LG, Stannard AA, Yager JA. Veterinary Dermatology. 1997;8147-156.
Psittacine circoviral disease (PCD) affects parrots and related species and is often fatal to birds that contact it. They can become infected through the oral cavity, nasal passages, and through the cloaca. High concentration of the virus are shed in feather dust from infected birds.
Bobita, was one of those unfortunate birds. He is a juvenile male cockatiel, bought from a pet-shop about 3 months ago, when he was 4 months.
The owner noticed that the bird is singing more and more rarely, and when he does, the voice is hoarse. Beside this, he also noticed that the animal is losing his feathers. The owner thought it might be a hypovitaminosis, so he started to give him vitamins. When he noticed bleeding on the base of the feathers he scared and made the decision to bring him to the vet.
During the consultation we noticed that the bird easily loses his plumage, he does not have any destructive feather behaviors or feather picking. He had a poor feather quality, they were more discolored than normal and the shape was abnormally (curved and stunting of the feathers). A part of the feathers on the head was lost. Feather dystrophy, hemorrhage within the pulp and circumferential constrictions of the feather shaft were observed. The beak started to pigment and there was a slight exfoliation, claws were longer than normal.
Ectoparasites, viruses (circovirus [PBFD], polyomavirus), genetic conditions. Other factors that may negatively affect feather condition are low humidity, exposure to aerosols, cigarette smoke or other toxins, malnutrition and chronic systemic illnesses (hepatopathy, nephropathy).
Microscopic examination of the pulp and feather were performed. In the examined samples there were no evidence of fungal, bacterial or parasitic infections. A PCR exam was performed from growing feathers pulp to detect PBFD virus DNA.
Treatment and prognosis
Because the disease is not in a very advanced stage supportive treatment focused on the stabilization of the immune system, a balanced diet and a stress free environment was recommended. The most important prevention is the hygiene of the cage and educating the owner how to disinfect, because they represent a risk of spreading the disease.
Feather loss might be acceptable, but beak and claws changes are painful and usually a reason for euthanasia
Vet Point Vest
This is the story of Chucky, a senior 9 year old european male neutered cat. He used to live in an outdoor environment. His medical history is very long, since he was young he had different pathologies from infectious diseases, chronic urolithiasis ended with urethrostomy and a femur fracture osteosintesis.
Chucky was a well monitored patient with all his dewormings and vaccinations on time.
Chucky was presented for a clinical consult because the owner noticed something on his skin. On the first clinical presentation I found two skin lesions (papules) about 0.5 cm diameter non ulcerated on the dorsal thorax, well circumscribed that made my think of piogranulomatosis pioderma. I started a treatment with amoxicillin + clavulanic acid and asked them to come back after 7 days. At the second consult, Chucky looked exactly like in the pictures, he was suffering of a generalized nodular ulcerated dermatitis.
A skin biopsy was made the next day and the sample was sent to the histopathology lab.
Pathology findings : the superficial and profound dermis are infiltrated with neutrophils, macrophages, histyocitic mesenchymal cells with atypical mitosis and eosinophils and also areas of necrosis and hemorrhage (histovet.ro) = piogranulomatosis pioderma with histiocytic neoplastic component
DIAGNOSIS : Progressive non-epiteliotropic feline histiocytic disease
Histiocytes are mesenchymal cells derived from the bone marrow as stem cells. They either become macrophages or dendritic cells (antigen presenting cells APC). Dendritic cells can be also divided into Langerhan cells, interstitial dendritic cells or interdigitating dendritic cells.
Using immunophenotyping methods the histyocites were found expressing CD1a, CD1c, CD18 and MHC class 2 molecules used specific for dendritic cells and not Langerhan cells.
Feline Progressive Histiocytic disease is a benign skin neoplasia in humans and dogs but it is extremely rare in cats. In a 2006 study conducted by Affolter and Moore (VetPathol.43(5)646-55) it is said that except some case reports this disease has not been characterized in cats. They analysed the cases of 30 cats with FPH and summarized that there is no breed or age predilection, that females are more prone on developing this disease and that it is a fatal one with no successful treatment options.
- Multiple papules with red margins, non-pruritic on the body especially on the dorsal and lateral thorax
- Ulcerated nodules on the head and ears also non-pruritic
- Periauricular alopecia with hyperpigmentationPrognosis:
FPH is a slowly progressive skin neoplasia that does not cause any pain but will spread behind the skin in the terminal stage. Median surviving time is 13.5 months.
It is considered only paliative. At the time of my diagnosis I started treatment with Prednisone at a 2mg/kg/24 h but there was no evidence of improvement. Lomustine (CCNU) is an antineoplastic drug that is used for the dog’s histiocytic disease and may be used in the cat as well at a dosage of 40-60 mg/m2 every 3-6 weeks.
According to the book Small Animal Clinical Oncology (2012) the skin lesions do not appear to respond to corticosteroid therapy and effective medical treatment as not yet been described.
What happened to Chucky: Chucky was brought for humanly euthanasia after 2 months after the diagnosis because of dyspnea and anorexia. I suspect pulmonary metastasis was present at that time but the owner refused necropsy.
Congenital follicular parakeratosis is a hereditary disorder affecting females, which suggests a X-linked mode of inheritance, the particular aspect of the condition is not affecting the skin of the nose and footpads unlike other seborrheic disorders.
More about this particular condition can be found in Small Animal Dermatology 7th Edition.
This particular case seemed interesting as it occurs very rarely and even more so there are few cases when owners are willing to do everything they can to keep them in good shape.
Female stray dog presents to our clinic in gravely bad shape, with serious skin scaling , waxy material clumping together most of her coat, runny eyes and greasy smell.
Comes from a litter of 3 puppies, her other brothers being already twice her weight, with normal skin condition
Age: 2 months
Sex: Female, Mixed breed
Waxy material concentrated mostly on the edges of the pinnae and on her neck
Waxy material covering most of her body, creating clumps of hair, general aspect of a dirty dog
Due to the severity of her condition, several tests have been performed to exclude potential affections:
*CDV test – negative
*Otoscopic examination: Billateral ceruminous otitis, with buildup waxy hair follicles inside the ear canal
*Skin scrapings: Negative for ectoparasites
*Cytology from different sites of affected skin – keratinocyes, corneocytes accompanied with malassesia, no other signs of inflamation present
*Cytology from ears- copious amounts of ceruminous debris, flourishing with malassesia
*Cytology of the conjunctiva- chains of cocci, macrophages and neutrofiles
*Trichogram revealed normal hair structure, mostly in telogen phase, but embedded in a dense brown waxy material.
*Giardia test- negative
*Moderate Toxocara infestation
After ruling out most of the possible diagnostics, Demi was reexamined closely looking for particularities.
-It turned out that the keratosis was affecting especially the external areas of the pinnae, the ventral side of the neck, the entire back and along the limbs and in a smaller part the abdomen.
-It was peculiar that the skin on her nose was normal, as well as her footpads, which led me into thinking about this possible condition, that could only be 100% proved with a skin biopsy.
-Unfortunately the owner who rescued her did not agree with the biopsy so I had to move onto the therapy without knowing 100%, but shortly after I was sure that this was it.
-Demi remained at the clinic for 2 months, giving us time to use proper treatment such as:
-Frequent bathing (2-3x/week) with Benzoyl peroxide followed by mixed shamoo (ketohexidine) and a conditioner
-High quality protein diet based on salmon
-Daily Omega 3 and 6 oral suppliments and weekly spot ons.
-Daily Vitamin complex with high ammount of vitamin A and E
-The otitis externa was treated with Clorexyderm oto and Surolan 2x/daily for 14 days
-The conjunctivits was resolved with cloramfenicol drops and daily cleansing of the ocular area – the hyperkeratosis also affected her eyelashes, constantly irritating the eyes, I had to remove each affected lash.
-She received deworming pills and sarolaner to control the endo and ectoparasites.
DEMI AFTER 7 DAYS OF TREATMENT
DEMI AFTER 14 DAYS OF TREATMENT
DEMI AFTER 1 MONTH OF TREATMENT
DEMI AFTER 2 MONTHS OF TREATMENT
As you can see, her condition can be kept under control especially if the owner understands that it’s a lifetime condition and she will require special treatment for the rest of her life
She had a brief period of time when I decided to see how long it takes until new keratin materials starts to form if I stop the treatment and it only took 6 days for the most affected areas to relapse.
It’s a rare condition, I was especially glad to be able to care for her and to see that there are people willing to do everything needed to keep her in good shape
I’m pretty sure most of these dogs don’t survive long if in the wild, or are discarded by breeders if not, let’s say Demi was lucky enough to be rescued at such a young age.
Veterinaru clinic VitalVet
Information about the patient:
Species: Canis familiaris
The dog had been treated for 14 days at another veterinary clinic for allergy with steroidal non-inflammatory drugs and antibiotics (amoxicillin and clavulanic acid).On presentation at our clinic the owner complained about the fact that the dog was pruritic and had the lesions presented in the pictures shown below.
Skin citology, Gram stain: Gram positive, rod shaped cocci (Staphylococcus spp.);
Wood lamp examination: positive;
Trichogram: swollen, frayed hair with irregular outline; cortex and medulla structure – abnormal;
Deep skin scraping: positive for Demodex.
Diagnostic: Demodicosis with secondary pioderma and fungal infection (dermatophytosis).
– Simparica (sarolaner) 1x/month, repeat until 3 consecutive negativ skin scrapings;
- Marbofloxacin, 21 days;
- Bathing with therapeutic shampoo (ketokonazol, clorhexidine formulation) every 3 days;
- Every 3rd bath another therapeutic shampoo was used (benzoyl peroxide);
- Dermoscent Pyo spot-on, 1x/week, 4 weeks;
- FortiFlora probiotics.
Topical gel with onion extract and heparin;
Follow up after 1 month:
After 3 months from the initial consultation:
Dog, yorkshire terrier, F, 6 years old, spayed, vaccinated, dewormed and with fleas and ticks treatment done, 2 kg. She has been scratched for 2 weeks. A new cat was brought home three weeks ago. The cat present areas of alopecia on the tail.
Circumscribed lesions on the shoulder (Fig. 1) and on ventral cervical region (Fig. 3), areas of round shaped alopecia with erythema, scaling.
Remaining hairs may appear broken off.
Positive Wood’s lamp examination – apple green glow associated with the root of each hair (Fig. 2)
Matt fur examined with Wood’s lamp:
auricular pavilion (Fig. 4) and cervical ventral (Fig. 5) positive, fluorescent hairs.
A true dermatophyte infection reveals an apple green fluorescence on the roots of the hair.
Other differentials (ex. demodicosis, superficial pyoderma).
Wood’s lamp examination: typical yellowish-green fluorescent hair shafts that can be given by Microsporum canis strains; only Microsporum canis fluoresces and in only about half of cases. The Wood’s lamp is useful in establishing a tentative diagnosis of dermatophytosis in dogs and cats but false-negative and false-positive results are common. Definitive diagnosis is established by DTM culture.
Trichogram: misshapen hair shafts infiltrated with hyphae and arthrospores.
Deep skin scraped: negative
Topical antifungal treatment applied on whole body twice a week, for 6-8 weeks until the result of the DTM culture is negative. Bathing are recommended to be done with shampoo containing chlorhexidine and an antifungal (ex ketoconazole) after the animal has been clipped. Ointment containing clotrimazole applied locally in thin layer, daily.
Environment: Decontamination measures in the house, where the animal stood (changed and washed carpets, bedding, beds, pillows), taking all measures to remove spores.
Supplements based on Omega 3 and Omega 6, which will help reduce pruritus and inflammation.
The prognosis is good. However, it should not be forgotten that dermatophytosis is a contagious disease that can be transmitted to other animals and humans.
Bajenaru Daniela (Tazy-vet), Bucharest, Romania
Jack, metis, 5 months, adopted from a shelter and treated against Parvovirus infection.
Prinary lesions: alopecia areas on the head, no other types of lesions were observed.
Two weeks after parvovirosis episode, dermatological problem has begun to progress
Wood’s lamp examination
Microscopic examination of the skin scrapings
Hair plucks (trichoscopy)
Color dilution alopecia and other fololicular dysplasias
Wood’s lamp examination- Negative
Microscopic examination of the skin scrapings- Negative
Trichoscopy- irregular distribution and clumping of melanin which distorts the hair shaft.
Fungal culture- Negative
Fig 1,2,3,4- Trichoscopy examination: large grains of melanin which distorts the hair shaft.
Skin biopsy and histopathology reveal macromelanosomes, melanin clumping and follicular dysplasia.
COLOR DILUTION ALOPECIA
There is no effective treatment for this disorder. The disease is progressive and incurable.
avoiding excessive brushing and shampooing
antimicrobial and keratinolytic products only when needed A high-quality DIET and essential fatty acids
after 6 months
Marina-Ştefania Stroe, DVM
Dog, half breed, M, intact, 4 years old, unvaccinated and without treatment for intestinal parasites, fleas and ticks, 10.2 kg.
The main concern was the ophthalmologic problem.
Three weeks ago he had problems with the hind limbs and he had difficulty in moving. Previous treatments: meloxicam, gentamicin, steroidal anti-inflammatory.
The possibility of ingestion of a toxic (plant / substance) is not excluded.
-white mucous membranes, no lesions in the oral cavity;
-necroses in the auricular pavilions with a visible marginal line, foreskin necrosis, yellow crusts and areas of necrosis predominantly on the posterior limbs, tail, dry-looking fur, which is easily detached;
-after detachment, the skin is denuded, ulcerated, very painful on palpation;
-minimal normal auricular secretion;
-corneal erosions, dry eyes, agglutinated secretions at this level;
-faded cardiac noise; imperceptible pulse;
-rectal examination: doughy feces consistency, normal color;
-abdomen in tension;
-blood pressure (indirect oscilometric metod): 138/102 (112 mmHg).
-Chest and abdomen rx and ultrasonography: free fluid; enlarged spleen.
-Ultrasound guided abdominal puncture: yellowish ascitic fluid, orange tint, after spinning small, white deposit. Protein: 1 g / 100 ml.
-Blood tests: low red blood cell counts, thrombocytopenia, leukocytosis, granulocytosis; elevated liver transaminases, bilirubin and amylase normal values, normal kidney parameters.
-Bleeding time: normal.
-Negative tests for infectious diseases.
-Abdomenocentesis: 335 ml of ascitic fluid and cytological exam: MODIFIED TRANSSUDAT WITH ERYTHROCYTE POLLUTION
Fig. 9: Cutaneous cytology, direct impression smear from necroses of the pinnae (Fig.10): nonsegmentated immature young neutrophils, lymphocytes, few macrophages in whose cytoplasm are found bacilli, bacterial population predominantly represented by bacilli, but also cocci, oxyphilic cell matrix
Fig. 11: Cutaneous cytology, direct impression smear from yellow scale, tail (Fig. 12): neutrophils in all stages: mature segmented, degenerative stage, but also young with eukromatic nucleus and evident nucleoli, macrophages with basophilic cytoplasm, slightly vacuolized, eucromatic nucleus, nucleic streamming, erythrocyte infiltrate.
Fig. 14: Tape prep from yellow scale, hind limb –
keratinocytes on the surface of which are attached cocci, degenerate inflammatory cells
Fig. 13: Trichogram – hair with normal structure, some hair with degraded cuticle, rap A / T: 4/6, follicular cast, negative for demodex and dermatophytes.
Superficial and deep skin scrapes: negative.
-Direct and consensual pupil reflex present;
-Reduced visual acuity;
– Schirmmer test 0 mm / min;
-Florescein test: Positive
Diagnosis: OU Corneal melting ulcer F +
Diagnosis and other differentials
Blood smear, cell morphology: moderate, hypochromic, regenerative anemia,; leukocytosis, neutrophilia, moderate non-specific cellular toxic status, eosinopenia, lymphopenia. In this case, the leukogram (neutrophilia, eosinopenia and lymphopenia) may suggest treatment with corticosteroids, stress, hyperadrenocorticism, severe inflammation (chronic) with various etiologies (viral, bacterial, fungal).
Skin biopsy: histopathological aspects advocate for hyperkeratosis with paracheratosis and chronic inflammatory response involving the epidermis, jonctional area and superficial epidermis.
Histopathological aspects may show Erythema multiforme or TEN (toxic epidermal necrolysis – toxic shock syndrome), which is a late reaction, surprised in a chronic, secondary phase due to fibroblast proliferation.
The toxic shock syndrome may be a reaction to drugs, chemicals or food
Enrofloxacin (dose: 5 mg / kg) at 12h po;
Amoxicillin and clavulanic acid (dose: 20 mg / kg) at 12h po;
Furosemide (dose: 5 mg / kg) at 12h iv;
Tramadol (dose: 2mg / kg) at 12h iv;
Acetylcysteine, Tobrex, Corneregel 6-7 times / day (lack of tears).