Green coat, hypothyroidism,lymphoma and carcinoma of the sebaceous glands.

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Dr Spas Spasov

Dr Spas Spasov

Unites Veterinary Clinic

City of Varna, Bulgaria

 

   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.123

   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

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   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).1112
The levels of levothyroxine were low at 11nmol/L  and so there was a need to increase the dose.
Due to personal reasons, the owners could not make a follow up consult for another month.Their next visit was actually about three months later and the situation with Cleo was extremely poor.131415
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.