Demodicosis with secondary pioderma and fungal infection (dermatophytosis).

31218656_1929341830411951_7466975273171288064_nDr Daiana Debreczeni

Veterinaru clinic VitalVet

Oradea, Romania.

 

Information about the patient:

Name: Lala

Sex: Female

Age:10 months

Species: Canis familiaris

Breed: Mix

Medical history

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.

IMG_0997 IMG_0998

 

 

 

 

 

 

 

 

IMG_0988 IMG_0994 IMG_0987

Diagnostic tests:

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).

 

Treatment:

 

– 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:

IMG_1146 IMG_1153 IMG_1154 IMG_1155

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

After 3 months from the initial consultation:

 

48370418_299299174033893_6871986109262331904_n 48392732_266569077305066_4483729918953259008_n 48376231_563513447463071_1721448816659398656_n 48408389_284540192407843_6492582261840412672_n

Plasma cell pododermatitis, an imune-mediated dermatosis

27657905_1767922679940615_5207571160505979701_nDr. Nadasan Giulia
VetPoint Vest
Arad, Romania 
Patient: Mufi

Species: feline
Age: 6 years
Environment: household with 15 other cats
Clinical findings: soft, scaly swelling of all the 4 paws, one of them apears with crusts.Only the footpads were afected. The lesions appear to be painful, no pruritus.
Diagnosis: plasma cell pododermatitis, an imune-mediated dermatosis
37296260_2252346914780053_1791624317373513728_n 37303145_2252346888113389_763843415149379584_n 37357272_2252346874780057_3680124293577965568_n
Frequency: rare
Cause: it is idiopatic but asociated with FIV infection
Treatment: steroids.
first 4 days prednisolon-acetate 4 mg/kg i.m, next 7 days at home metilprednisolone 2 mg/ kg

Color dilution alopecia

 

Dr Daniela Bajenaru

Dr Daniela Bajenaru

Bajenaru Daniela (Tazy-vet), Bucharest, Romania

 

 

History

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 progress2

 

Physical examination

Poor quality of the hair coat, the hair was thinner and dry
Symetrical hair loss on the auricular pavilions.
Progressive, partial, patchy alopecia and stubble
Non-inflammatory lesions
Non-pruritic31

 

 

 

Investigations

Wood’s lamp examination
Microscopic examination of the skin scrapings
Hair plucks (trichoscopy)
Fungal culture
Biopsy
Histopathological examination

 

Differential diagnosis

 

Dermatophytosis
Demodicosis
Pattern baldness
Color dilution alopecia and other fololicular dysplasias

Laboratory results

Fig.1 Trichoscopy

Fig.1 Trichoscopy

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.

 

fig 3

fig4

fig4

fig 2

fig 2

 

 

 

 

 

 

Skin biopsy and histopathology reveal macromelanosomes, melanin clumping and follicular dysplasia.

 histopathology reveal

histopathology reveal

 

Diagnosis

COLOR DILUTION ALOPECIA

Treatment

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 acids20170330_18223220170330_181007

Evolution

after 6 months

evolution

evolution

evolution

Erythema multiforme or TEN (toxic epidermal necrolysis – toxic shock syndrome)

stef art

Marina-Ştefania Stroe, DVM

Marina-Ştefania Stroe, DVM

Romania

History

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.

Clinical exam

-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;

-cutaneous hyperesthesia;

-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).

Picture4Picture3

TESTS

-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

Picture6

Fig 10

Picture5

Fig 9

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

Picture7(1)

Fig 11

Picture8(1)

Fig 12

Fig. 13: Trichogram – hair with normal structure, some hair with degraded cuticle, rap A / T: 4/6, follicular cast, negative for demodex and dermatophytes.

Picture10

Fig 14

Picture9

Fig 13

Superficial and deep skin scrapes: negative.

 

 

 

 

 

 

 

 

 

 

 

 

Picture11

Fig 15

Fig. 15:

-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.

Final diagnosis

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

 

Treatment

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;

Parenteral nutrition;

Bathing (chlorhexidine);

Acetylcysteine, Tobrex, Corneregel 6-7 times / day (lack of tears).

 

Hypothyroidism in dog

10615967_4509428271902_7318235873151930765_nDr. Marta Todorova

Veterinary Clinic Ruse, Bulgaria

 

Clinical case

Case description

Dog , male , entire, five years old was evaluated because of signs of hair loss. The name of the dog is Ares. He lives in apartment with his owners.

History

About two years ago the dog has easily epilated hairs. The coat is typically thin on the neck  , on the head and on the trunk symmetrically. The is crusts  on the all body. Some parts of the skin are depigmented. Alopecia is growing to the tail. Hair regrowth non  existent.It was unhappy dog.

dav

dav

dav

Diagnostic approach

  • Skin tests
  • Brushing test- a lot of crusts
  • Scotch test – negative
  • Cytology – negative
  • Scratch test – negative
  • Trichogram – more hairs in telogen phase
  • Blood test – FT4 7.84 pmol/l

 

 

Therapy

-Levothyroxine 10micrograms/ kg/2twise daily

-Dermoscent – ones a week, for four weeks

-Dermacomfort

– washing with Sebolytic

 

There are visible results two months after therapy and the dog regained his previous behavior.

Blood test after therapy – FT4 19.17pmol/l

dav

dav

Fibrosarcoma in rabbit

13645233_1318532268176553_6937383040185403316_n

Dr Spas Spasov

Dr Spas Spasov

United veterinary Clinic Varna, Bulgaria

 

Fibrosarcoma in rabbits are malignancy rapidly grow soft tissues tumor. Can affect cats dogs and rabbits . The couse of fibrosarcoma in rabbit also can be a viral infection (polyomavirus, malignant rabbit fibroma virus)

Clinical case

Case description
Rabbit, female , entire , 5 years old was evaluated because of sings of anorexia and apathy .
History
The owners reported  that a week ago the rabbit progressively stops  eating. The last two days it didn’t eat at all. Тhe rabbit has regularly deworming and vaccination.
The rabbit eats hay and rabbit granules only and lives in an apartment and  never go outside, there are no others animals in the apartment.

19679595_1713702035326239_246743106_n 19720422_1713702041992905_1551514530_o 19723892_1713702011992908_958302465_o
Clinical manifestations
Anorexia, cachexia, apathy, unilateral uveitis, normal temperature (38.5).
Clinical examination revealed all of the body (back, neck, abdomen and all the legs) nodules, which are not painful, mobile, not tempered and pigmented .The size of the nodules was variable from 1 to 5 centimeters.
Some nodules were ulcerated and bleeding, and still painless. Such formations are not observed in the nose and the ears, and the front part of the head.
Diagnostic approach:
We did not find any abnormalities on the X-ray examination of the chest and abdomen. A nodule was surgically removed by cutting.
Symptomatic therapy was appointed until the results of the histopathological examination:
Metoclopramide-0,5mg / kg
Ranitidine-4 mg / kg
Simethicone-65mg / rabbit
Meloxicam-1mg / kg
Enrofloxacin, 10 mg / kg
Intravenous infusion Hartman 4ml / kg / hour.
So designated therapy lasted about 10 days pending the results of pathological examination The condition of the animal slightly improved, which is expressed in phrases in appearance of appetite. The animal took small amounts of food.

Diagnosis:

Fibrosarcoma
The prognosis for this type of tumors is garded to poor. Because of poor condition of the patient and the prognosis owners decided to euthanased the rabbit.

1st Bulgarian Dermatology Congress , organised by BAVD

14612382_553114001550481_6070253379668782534_oFirst Congress of Bulgarian Association of Veterinary Dermatology held in 27-28th of April, 2017 at city of Plovdiv, Bulgaria. There were more then 120 veterinarians from Bulgaria, Macedonia, Romania, Greece and Cyprus.

18209292_640039056191308_9139044102961873525_o 18193187_640588769469670_5244865418136719896_o

Dr. Emmanuel Bensignor and Dr. Sebastian Viaud, who impressed the audience with the way information was provided, but also the way all the scientific information was presented so to be useful in every-day-practice. They   discussed which one is the best elimination diet, which medicine is effective in the control of canine atopic dermatitis and how to use them appropriately? How to do Desensibilisation therapy? How to perform biopsy from unusual places? How to recognize vasculite lesion and how to deal with it?18209350_640038969524650_2972147177502418052_o

Vets on The Balkans support BAVD submit one free ticket for 4th Latin American Congress of Veterinary Dermatology to be held in
Merida, Mexico from 13th to 16th of June 2018  and one free ticket for 4th Romanian Dermatology Congress , October, 2017. Their members are presenting clinical reports and the best one will win. All of the cases will be posted in the journal Vets on The Balkans.

18076763_640038906191323_3770134851450354649_o 18118445_640588669469680_5880784995554696396_n

Dr Ana Maria Boncea, Vetderm Therapy in Bucharest, Romania

 

“I would like to thank you one more time for this opportunity. It was great event!! Congratulations for everything! See you soon!!”

 

Dr Daniela Bajenaru, Tazy Vet Veterinary Clinic in Bucharest, Romania

 

“Dear Luba, the 1st Bulgarian Veterinary Dermatology Congress was excellent, the lecturers gave us a lot of useful information and the organization was great!”

 

Dr Adriana Cosma, Conforvet on Bucharest, Romania.

 

“ Hi Luba! I wanted to tell you that we thank you for everything…we had wonderful time. We liked very much the BAVD Congress and the city of Plovdiv!”

 

 

The team of Vets on The Balkans congratulated BAVD for the high professional level of organizing and the brilliant scientific program.

CANIN HYPERCORTISOLISM (CUSHING SYNDROM)

daniDr Daniela Bajenaru

Tazyvet veterinary clinic

Bucharest, Romania

 

Singalment and hystory

 

Bella, presented on 12/13/2016

10 year old, female, Labrador retriever

5 month history of polydipsia, polyuria, polyphagia and pruritus

 

Physical examination

 

Abdominal enlargement

Palpable hepatomegaly

Thin, hypotonic skin, easy bruising

Phlebectasias

Erythema

Calcinosis cutis over the dorsal neck, thorax and rump

Bacterial pyoderma

 

 

 

6 1 unnamed7

 

 

 

8 9 4 10

Investigations

Ultrasound

Urinalysis

Coagulation time

Serum chemistry panel

Trichogram, scoch test

Bacteriological examination

ACTH stimulation test

 

Laboratory results

Ultrasound- hepatomegaly

Urinalysis – low specific gravity (1.005)

Coagulation time – 5’

Serum chemistry panel: GPT -361,  ALP>1980, CHOL- 215, CREA -0,587, UREA -25,2

Trichogram/ scoch test – no significant findings

Bacteriological ex. – Staphylococcus aureus  (++++)

Basal cortisol level  > 10 µg

ACTH stimulation test – cortisol= 29,4 µg/dl

Diagnosis

CANIN HYPERCORTISOLISM (CUSHING SYNDROM)

SUSPICION: PITUITARY DEPENDENT

 

Treatment

TRILOSTANE -120 mg once daily

Amoxicillin with clavulanic acid -12,5 mg/kg/12h, 30 days

Probiotics

Topical: – moisturizing and desinfectant shampoo, once weekly

– antiseptic, anti inflammatory and healing gel, once daily

EFA supplements

Diet: low fat

EVOLUTION

After 3 days of topical treatment

15

After 3 days

Basal cortisol level      > 10 µg/dl

13

After first bathing

 

 

Bella1

21

After 7 weeks basal cortisol – 5,3 µg/dl

22

After 7 weeks basal cortisol – 5,3 µg/dl

Bella3

The evolution to be continued ….

Ehlers-Danlos syndrome (EDS) in cat

666c2612-831a-4ddc-89b0-75c5c54120f0

Dr Iva Nikolova

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.797fdd08-babf-4af0-9124-fef85d0b13cbd596bb7d-7962-4e16-90d5-5bee9a19ef48521b849f-40cf-48c2-9054-58b2949e8e5f

 

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.DSC_6291980721_1678618725745068_3290500551826602685_o

 

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.

 

 

Demodex injai associated with Anaplasma spp and epiteliotrophic lymphoma in a 9 year old male Akita

Case report

unnamed

Dr Alberto M Cordero

A. MARTIN CORDERO
vetderm25@gmail.com

*VETDERM: Dermatologia Veterinaria Especializada, Guadalajara, Mexico
Assistant professor Department of Veterinary Medicine, Centro Universitario de Ciencias Biologicas y Agropecuarias, University of Guadalajara; Guadalajara, Jalisco, Mexico

A male non neutered 9 year-old Akita was presented with alopecic focal crusty lesions on rear and front limbs. Hemorrhagic lesions were observed on the front limb and history of tick infestation was provided by the owner. Ulcerative and nodular lesions were present on the right lateral aspect of the face. Skin scraping revealed presence of Demodex injai. .2014-01-28 19.20.56 ELISA rapid testing IDEXX 4DX was performed to confirm tick borne disease revealing positivity to Anaplasma spp. 2014-01-28 19.21.102014-01-28 19.21.302014-01-28 19.22.302014-01-28 19.14.152014-01-28 19.14.02Skin biopsies were taken from the face and abdomen revealing large atypical lymphocytes with epitheliotrophism consistent with epitheliotrophic lymphoma. The patient was presented one month later with pleural effusion, euthanasia was performed.

A male non-neutered 9 year old Akita was presented with history of focal crusty lesions. Due to his geographic origin from the North of Mexico close to the border with the United States and comments from the owner about tick infestation an ELISA SNAP 4dx plus test (Idexx) was performed.

SNAP test was positive to Anaplasma spp.

CBC showed no abnormalities.

Cutaneous lesions observed include, crusty and erythematous lesions in the abdominal regions, crusts, erosion and ulceration in the muzzle and petechial and ecchymosis in the front left limb.

A deep skin scraping was performed revealing the presence of long body Demodex compatible with Demodex injai.

Treatment with weekly Doramectin at 0.5mg/kg was started in conjunction with Doxycycline at 10mg/kg per day.

After 5 weeks of treatment owner reported depression and decrease of food ingestion, also, the appearance of new lesions in the muzzle region. Physical examination show nodular and plaque erythematous formations in the face and ventral region.

Cytology by fine needle aspiration was performed revealing atypical lymphocites characterized by cluster aggrupation, anisocytosis, and prominent nucleoli.2014-03-10 20.04.042014-03-10 20.04.082014-03-10 20.04.122014-03-10 20.04.152014-03-10 20.04.32

Three biopsies were taken using a 6mm punch biopsy and sent to dermatopathological examination. Results of the biopsy showed large atypical lymphocytes with epitheliotrophism consistent with epitheliotrophic lymphoma.

2 weeks later the patient was presented with pleural effusion and respiratory distress. Euthanasia was performed by owner request.IMG_1567

Conclusions

Demodectic mange may appear in a juvenile or adult onset presentation, as well as generalized or localized form. Patients with adult presentation should be screened in search for underlying conditions. In most cases underlying conditions will not be found. In order to control the disease, primary cause should be treated and corrected1.

Correct approach to dermatological conditions include a well-detailed clinical history and diagnostic test according to lesions found. We should be aware of perform all the diagnostic dermatological test we need, du to the fact, there are several dermatosis associated with secondary factors or associated conditions.

 

1.- Mueller, R. S., Bensignor, E., Ferrer, L., Holm, B., Lemarie, S., Paradis, M., & Shipstone, M. A. (2012). Treatment of demodicosis in dogs: 2011 clinical practice guidelines. Veterinary Dermatology, 23(2), 86–e21