Ear tip vasculitis in a Bull Terrier dog – case report

Dr Giulia Nadasan-Cozma

Giu The Vet- veterinary clinic

Arad, Romania

Pacient data and history:

Name: Connor

Breed: Bull Terrier

Age: 2 years

Patient presented for a dermatological consult after a few days of bleeding from the auricular pinnae.

The owner noted that the onset was acute, the lesions appeared “ overnight” and the animal was bothered by them, and started scratching and bleeding.

Dermatological findings:

Vasculitis lesions are noted bilaterally on the apex of the pinnae consisting of  alopecia, ulceration, crusting in different stages and necrosis that led to loss of tissue and altered the shape of the pinnal apex.

The crust comes off very easily and hemorrhage starts.

Lesions begin at the apical margins of the pinnae and spread along the concave surface.

Diagnosis:

Diferential diagnosis:

Proliferative thrombovascular necrosis of the pinnae is the dermatological diagnosis but to confirm this diagnosis, a biopsy and a histopathology exam is needed.

Ear tip ulcerative dermatitis can be another dermatological diagnosis.

Vaccine associated vasculitis can be another cause.

Vasculitis can be associated with coexisting disease like hypersensitivity disorders, food allergies, insect bites and many drugs administration, even dexamethasone or prednisone.

Given the note that Connor is an atopic dog, atopy itself can be the reason these lesions appeared because he was treated with prednisolone over an year because of his atopic syndrome and owner’s budget restraints.

Treatment and outcome:

After a long talk the owner chose surgery but in the end we managed to convince him to try medication for at least 14 days.

The following treatment options were offered:

1: Oclacitinib

Dosage: 0.5-0.6 mg/kg/12 h

1 tablet of 16 mg to be given BID 30-90 days according to the studies

2.

• Local topical Tacrolimus 0,1%
• Pentoxifylline tablets, dosage 15mg/kg BID
• Doxicycline tablets, 5 mg/kg BID
• Niacinamide tablets 500 mg/dog TID, for 30-90 days, may not work.

Treatment with oclacitinib (Apoquel 16 mg) was started despite budget restraints and Connor started to get better by day 7.

The treatment lasted 7 weeks ( 49 days) until complete remission of lesions.

He continued with Apoquel 16 mg 1×1/24 h to control his atopic syndrome.

Conclusion:

Oclacitinib it is not typically used to treat vasculitis in dogs but should be included

among the therapeutic options for ear tip vasculitis if there are no signs of infection. Oclacitinib has immune modulatory effects on numerous cytokine-mediated inflammatory, autoimmune or immune-mediated diseases in dogs. This type of vascular damage of the pinna is sometimes idiopathic and is hard to find a definitive diagnosis without a histopathology exam.

References:

1. Silvia Colombo, Luisa Cornegliani, Antonella Vercelli, Alessandra Fondati – Ear tip ulcerative dermatitis treated with oclacitinib in 25 dogs: a retrospective case series (2021) – Veterinary Dermatology
2. Thelma Lee Gross, P. J. Ihrke, E.J. Walder, V.K.Affolter – Skin diseases of the dog and cat, 2nd Edition, 2020, Blackwell
3. Rosanna Marsella, Katherine Doerr, Andrea Gonzales,Wayne Rosenkrantz – Oclacitinib 10 years later: lessons learned and directions for the future

(2023) –  J Am Vet Med Assoc.

4. William H. Miller Jr., Craig E. Griffin, Karen L. Campbell  – Muller and Kirk’s  Small animal dermatology, 7nd Edition, 2012, Elsevier

Pemphigus foliaceus in a cat

   Dr Spas Spasov

Veterinary Center Dr Antonov

Varna, Bulgaria

  1.Case History

The cat is 3 y old ,female non castrated ,regular vaccinated ,tick and flea treatment with advocate .

The problem of the cat begane one year ago in with claw bed problems ( yellow puss from there ) ,the cat have also lesions on its ears and nose .

In other clinic in other country my other vet is start with antibiotics and steroid therapy (improvement for few months )

    2.Clinical presentation

Paronychia, crusty  and scaly nose ,crusty and scaly ears, pruritus, painful walking no other skin lesions and symptoms .

   3.Differential diagnoses

Fungal infection

Pemphigus Foliaceus

Demodecosis

Pyodermia

Allergy

    4.Diagnostic approach

CBC and Biochemistry –Unremarkable

DTM – Negative

Skin scrape and scotch tape – Negative

Cytology – Neutrophils ,bacteria ( cocci ) and acantholytic  cells .

Microbiology ( Staff .aureus )

5.Therapeutic approach

14 days Amoxicillin and clavulanic acid and topical therapy with chlorexiderm 4 % ( almost no improvement)

New cytology – Normal neutrophils and acantholytic cells (no bacteria )

Punch biopsy of nail bed .

Pathohistologi report :

Report – Histopathology release date: 23.02.2021

Description

• There were examined 5 representative sections (Hematoxylin-Eosin stain) from each sample, showing

similar histopathological appearance:

Epidermis with orthokeratotic hyperkeratosis, spongiosis and crusts (composed of acantholitic cells and

neutrophils). Superfcial and deep dermis show oedema, perivasculary to diffuse infammatory infltrate

with eosinophils, few mast cells, few lymphocytes and plasma cells. The hair follicles are in telogen and

catagen phases. The glands (apocrine and sebaceous glands) are well represented, without any

changes. There is no evidence of neoplasia, parasites or fungi in the examined sections.

• There were examined 5 representative sections (PAS stain – fungi) from each sample, showing similar

histopathological appearance:

NEGATIVE

Interpretation

The histopathological appearance is consistent with hyperkeratosis, suppurative epidermitis, chronicactive dermatitis with eosinophilic component (allergic component).

Comments

The histopathological aspects are suggestive for pemphigus foliaceus. Suspicion is confirmed.

Therapy :

Prednisolon tablets 2 mg per kg twice a day  for 14 days then slowly reduce dose to a minimum working dosage .

6 moths later the cat was perfect then ,the owners call regular just to tell us that everything is ok .

Diagnose :

Pemphigus foliaceus

Canine juvenile cellulitis – a case misdiagnosed as meloxicam allergy

Authors:

Tsvetan Velev¹, Anna Valerieva², Plamena Novakova², Elitsa Valerieva³, Elena Petkova², Tsvetelina Lazarova¹, Maria Staevska², Miroslav Todorov¹

Affiliations:

¹ Veterinary clinic “Blue Cross”, Pancharevo, Sofia, Bulgaria;  ² Department of Allergology, University Hospital “Alexandrovska”, Medical University of Sofia, Bulgaria; ³ Dr. Shterev Hospital, Sofia, Bulgaria;

Abstract

Juvenile cellulitis (also known as juvenile sterile granulomatous dermatitis and lymphadenitis, juvenile pyoderma or puppy strangles) is a rare sterile granulomatous disorder that commonly affects the face, pinnae and submandibular lymph nodes of young puppies between 3 weeks and 8 months old. The condition often manifests with prodromal symptoms and concurrent medication / vaccination might be mistaken for culprit of hypersensitivity reactions.

Herein, we report a rare case of canine juvenile cellulitis misinterpreted as meloxicam allergy. Early diagnosis and proper treatment of the condition is associated with a very good prognosis. It is recommended that therapy should be aggressive and initiated as soon as diagnosis is made in order to avoid scarring, secondary infections and to maintain a favorable prognosis. Additional treatment includes topical medications (eg. antimycotics, antibiotics and steroids) along with antiseptic dressings. Awareness of this condition must be improved as the severity of juvenile cellulitis may lead to euthanasia, therefore it is of vital importance that the disease is considered and explored early, and proper treatment is initiated promptly

Key words: juvenile cellulitis, puppy strangles, canine drug allergy, misdiagnosis, autoimmune cellulitis, sterile granulomatous dermatitis, juvenile pyoderma

Introduction

Juvenile cellulitis (also known as juvenile sterile granulomatous dermatitis and lymphadenitis, juvenile pyoderma or puppy strangles) is a rare sterile granulomatous disorder that commonly affects the face, pinnae and submandibular lymph nodes of young puppies between 3 weeks and 8 months old (1). Clinical signs of juvenile cellulitis include fever, lymphadenopathy as well as bilaterally symmetric, pruritic lesions in the periocular areas, face, muzzle, pinnae and inguinal regions. Symptoms progress to crusting and alopecia. Lesions typically form fistulae that drain. A typical feature which also gave rise to the term “puppy strangles”, is submandibular lymphadenopathy. Apart from all these findings, affected dogs are usually active and in good general health (2,3).

Figure 1. Bilateral symmetric, pruritic granulomatous lesions of the muzzle and the periocular areas.

Case-presentation

A 14-week-old miniature Spitz-Pomeranian puppy (regularly vaccinated) spontaneously presented with left hind limb lameness and pain. A hypothesis of possible trauma resulted in intramuscular meloxicam application in two consecutive days with no clinical benefit. Dermatological symptoms occurred after 48 hours and were misinterpreted as meloxicam allergy: bilateral symmetric, pruritic lesions in the periocular areas, face, muzzle, pinnae and inguinal region. This lead to a prescription of antihistamine and low-dose corticosteroid treatment.

Thereafter, the puppy presented also with fever and mandibular lymphadenopathy. Dermatological symptoms progressed to crusting and alopecia, some pustules formed bloody abscesses and drained. Symptoms continued to worsen requiring to rule out various infectious diseases: canine distemper, leishmaniasis, anaplasmosis, babesiasis and toxoplasmosis, all of which resulted negative.

Blood tests were within reference ranges and non-conclusive of an infectious agent. Clinical presentation suggested a diagnosis of autoimmune juvenile cellulitis and high-dose systemic corticosteroid and antibiotic therapy was initiated with clear benefit in less than 12 hours: prednisolone 2 mg/kg + trimethoprim/sulfamethoxazole, together with ocal antiseptic care. Therapy was tapered in 35 days with no signs of a relapse. At the final check, the puppy is 17 months-old with normal development and in good general health.

Figure 2. Bloody abscess on the back (spontaneously drained within few days)

Discussion

The cause and pathogenesis of juvenile cellulitis are not yet fully understood. It was suggested that it is a systemic condition with primary lymphadenopathy resulting in secondary dermatological lesions with some extent of immune dysfunction as well as hereditary components (4). Inflammation in juvenile cellulites is pyogranulomatous with no culprit microorganisms. Cytological findings reveal a nonbacterial aetiology of the disease (5). Analysis of joint fluid often shows signs of sterile suppurative arthritis. Examination of aspirates of affected lymph nodes, pustules, abscesses and joint fluid rarely show any sign of bacterial growth. Biopsy of lesions usually demonstrate discrete or confluent granulomas and pyogranulomas consisting of clusters of large epithelioid macrophages with variably sized cores of neutrophils (6). It was also suggested that since juvenile cellulitis usually occurs at the age when dogs usually receive their first vaccinations with modified-live virus vaccines, there could be a possible pathogenic link between infection with vaccine or other viruses and the evolution of this disease. Data on this association is, however, insufficient. Definitive diagnosis is based on cytological and histopathological analysis as well as on typical findings on complete blood cell count (leucocytosis, neutrophilia, and normocytic-normochromic anaemia) (6).

Juvenile cellulitis is responsive to high-dose corticosteroids which are often prescribed along with antibiotics due to the risk of secondary bacterial infection (5). Rapid and aggressive therapy is recommended in order to maintain a favourable prognosis, to avoid scarring, and to reduce secondary infections (7). The major differential diagnosis includes: canine distemper, demodicosis, bacterial pyoderma, dermatophytosis or an adverse drug reaction, as in the case presented here. However, sterile pus on cytology and responsiveness to corticosteroid treatment differentiate infectious or drug-related causes from juvenile cellulitis. Since juvenile cellulitis is a relatively rare condition, it doesn’t usually come as the first diagnosis in mind and other more common conditions are considered (2). However, as the severity of juvenile cellulitis may lead to euthanasia, it is of vital importance that the disease is considered and explored early, and proper treatment is initiated (8). Juvenile cellulitis is very responsive to high-dose corticosteroids, usually prescribed along with (5). It is recommended that therapy should be aggressive and initiated as soon as diagnosis is made in order to avoid scarring, secondary infections and to maintain a favourable prognosis. Additional treatment includes topical therapy (e.g. terbinafine, oflaxacin, ornidazole and clobestal) along with antiseptic dressings (7).

Figure 4. Dermatological changes of the penile skin.

Conclusion

We report a rare case of canine juvenile cellulitis misinterpreted as meloxicam allergy. If diagnosed early and treated properly the condition is associated with a very good prognosis. It is recommended that therapy should be aggressive and initiated as soon as diagnosis is made in order to avoid scarring, secondary infections and to maintain a favourable prognosis. Additional treatment includes topical medications (e.g. antimycotics, antibiotics and steroids) along with antiseptic dressings. Juvenile cellulitis has a very good prognosis if diagnosed early and treated properly. Complete recovery is typical with a low chance of recurrence (9). Dogs’ condition usually improves markedly by the 14^th day after treatment start. Symptoms are reported to resolve completely within the fourth week (7).

Awareness of this condition must be improved as the severity of juvenile cellulitis may lead to euthanasia, therefore it is of vital importance that the disease is considered and explored early, and proper treatment is initiated promptly.

References:

1. Kumar AA, Pillai UN, Aipe AA. Clinical management of juvenile cellulitis in a dachshund pup. Intas Polivet 2013; 14:234–235.
2. Hutchings SM. Juvenile cellulitis in a puppy. Can Vet J 2003;44: 418–49.
3. Scott DW, Miller WT, Griffin CE. Small Animal Dermatology, 6 ed. Toronto: WB Saunders, 2001:1163–1167.
4. Dubey P, Sarkar S. Therapeutic management of juvenile cellulitis in Labrador pup. Intas Polivet. 2013; 14:232- 233.
5. Bassett RJ, Burton GG, Robson DC. Juvenile cellulitis in an 8-month-old dog. Aust Vet J 2005; 83:85.
6. Reimann KA, Evans MG, Chalifoux LV, et al. Clinicopathologic characterization of canine juvenile cellulitis. Vet Pathol 1989; 26:499–504
7. Martens S. Juvenile cellulitis in a 7-week-old golden retriever dog. Can Vet J 2016;57: 202–203
8. Mason IS, Jones J. Juvenile cellulitis in Gordon setters. Vet Rec 1989; 124:642.
9. Jyothi J, Preethi K, Sathish K. Therapeutic management of juvenile cellulitis in a Labrador retriever puppy. The Pharma Innovation Journal 2017; 6(11): 840-842

Demodicosis in cat

Case history

Puffy is a 1 y old stray cat.

Regular tick an flea control with Broadline, regular vacsinations.

The problems of the cats apears 6 months ago:

Sever pruritus, hypotrichosis and allpetia, ulcerations in difrient parts of the skin.

Multiple treatment:

Antibiotics, steroids, antifungal vaccinations and hydrolyzed diet (royal canin analergenic and purina hypoallergenic) No effect at all.

Case presentation.

The cate came to the clinic at 23.06.2020.

At that moment it was with acute pruritus, allopetia, hypotrichosis, ulcerations of the skin, a little bit waxy ears, low appetite for last two weeks.

The cat have negative FIV / FelV test, normal CBC, biochemistry unremarkable.

Diferentials :

Atopic dermatitis /Food allergy

eosinophil granuloma complex

Demodecosis

Dermatomycosis

Diagnostic approach :

Citology –Cooci bacteria ,neutrophils and just a few eosinophils

Trichogram :

Folicular casts and demodex cati

Deep skin scraping –Multiple demodex mites .

Treatment :

Credelio every month .

After seconde credelio the cat was adopted in Germany so we don’t see her in the end of treatment ,but the ownrs says that her skin is perfect now .

Conclusions :

Demodecosis is cats is less common compare to dogs ,but always have to be in diferentilas in cats with pruritus and waxy ears .

It could be with very pleomorphic clinic and always should be performed deep skin scrapyng if we suspect  demodecosis .

Panda mouse- case presentation

Dr Spas Spasov

Veterinary Center Dr Antonov

Varna, Bulgaria

Case presentation

Whole family of Panda mice (two adults and 12 babies) were presented at the clinic with acute and severe Pruritus and progressive history of hair loss for the past two weeks.

Clinical signs:

Severe Pruritus, Hypotrichosis, Seborrhea and secondary scratch wounds.

These symptoms are presented in all of the 14 mice.

Diagnostics:

Scotch tape samples from two of the babies and both adults.

All samples were positive for the parasite Myocoptes musculinus (dozens – male, female and eggs).

Coproparazitologic sample

Coproparazitologic sample

Fecal samples (native and flotation) were done – both were negative for endoparasites and positive for mites (adults and eggs).

Treatment:

Once a week – Ivermectine spot on and disinfection of the enclosure.

Data:

Myocoptes musculinus is the most common parasite in mice.

Typical affected areas are the neck, the head and the shoulders.

Oral Ivermectin doesn’t seem to be very effective. Environmental sanitation is vital.

There’s no data of zoonotic aspect .

REFERENCES:

Small Animal Dermatology 7th edition

The power of local therapy in superficial bacterial infections- part 2

Dr Spas Spasov

Veterinary Center Dr Antonov

Varna, Bulgaria

Sandra is a French bulldog whose case I have been following  for 2 years.

Sandra is regularly vaccinated and with regular tick and flea treatmen and dewormig as well .

When we first met, Sandra  was prescribed 2 mg of Prednisolone per kg in the morning and evening.

There were already 2-3 diets with hypoallergenic food with no results .

When the dog is on Prednisolone is very good, with no symptoms.

Sandra has been on immunotherapy for two years and during this time there are a total of 3-4 exacerbated periods with superficial bacterial infection.

To control these infections we tried various antibacterial shampoos and the ONLY systemic antibiotic we used was amoxicillin with clavulonic acid (at least one month ingestion)

During immunotherapy, Sandra takes 1/4 of Prednisolone at 5 mg every 36 hours (Sandra weights about 15 kg throughout the therapy).

For two years, Sandra was very good, and controlling the pyoderma was relatively easy without changing the doses of immunotherapy and without changing the dose of Prednisolone.

The last case of bacterial infection was the beginning of November 2019.

We began the scheme with Chloroxiderm and Amoxicillin with clavulonic acid.

10 days later, it had no effect, even the opposite.

Sandra’s skin was flushed with pustules, color and intense itching.

We did cytology, bacteriology and antibiogram.

The results (Staph. intermedius ) were completely resistant to 15 types of antibiotic from different groups.

The only antibiotic that worked was Rifampim, which is a strategic antibiotic in human medicine and we decided not to use.

Sandra’s improvement has been much slower and in the last few months we have changed several different regimens of local therapy.

Peptive Shampoo & Foam, Duoxo tampons & duoxo spo on  (First Month Every Day)

Omega 3 and 6 fatty acids, Chloroxiderm shampoo, Duxo pyo shampoo and foam (second month every day)

Since the beginning of January, Sandra has been on Peptive again with a bath twice a week and a hermitra spray.

The itching has decreased to normal, there are no new pustules and the hair is gradually recovering.

In conclusion, every time we use an antibiotic for systemic therapy or topical therapy, we should think very carefully about all the possible options because resistance is one of the greatest problems of our future.

Diagnosis :

Atopic dermatitis

Superfitial pyodermia

The power of local therapy in superficial bacterial infections- part 1

Dr Spas Spasov

Veterinary center Dr Antonov

Varna, Bulgaria

A topic not only for dermatologists.

“Recent high-profile reports warn of the dangers of not taking action. A bleak report by economist Jim O’Neill, commissioned by the British government and released in May, estimates that 700 000 deaths globally could be attributed to AMR this year and that the annual toll would climb to 10 million deaths in the next 35 years. The report projects US$ 100 trillion in losses by 2050 if nothing is done to reverse the trend.”

Aa quote from the World Health Association website.

1.Clinical case of Azar .

*HISTORY

Azar is a 3 years old cane corso dog.

There is a regular   vaccination  and tick and flea teratments  with tablets (isoxazolines).

Case history .

A month and a half ago, the owner has taken Azar to another clinic because of the many  pustules on the dog’s chin.

Clinical symptoms include itching in the facial area, redness, and many of about 0.5 cm pustules all over the chin.
Systemic antibiotic therapy and topical once-daily chloroxidine therapy were prescribed for Azar.

Two weeks later there was no change in the condition  of the dog.

Bacteriology and antibiogram were performed( Staph. Aureus ) , a second systemic antibiotic was added after the result (the first antibiotic was discontinued).

Staphyococcus aureus is extracted from the antibiogram.

Both antibiotics show the sensitivity of the causative agent.

Two weeks after the second antibiotic, there was no change in Azar’s condition.

2. Clinical presentation

At the initial examination, Azar was in good general condition, but there were numerous pimples throughout the chin area, which were very easily bleeding and pussing.

In addition, Azar defecates 3-5 times a day and most times the stools are not well formed.

3. We did cytology and deep scraping of the skin.

Cytology:
Mass neutrophils, macrophages, and cocci bacteria.

Skin scraping
No demodex or other parasites of deep skin scraping.

Initial therapy:

Local therapy with daily chloroxiderm shampoo, duxo pio tampons and duxo seb spot form and Diprogenta 0.5 mg / 1 mg / g cream

betamethasone / gentamicin for 10 days.

The effect after the first 10 days is significant and more than satisfactory, so the therapy prescribed after day 10 was changed only with shampoo with peptide.

10 days later, there were almost no signs of infection.

10 days later, Azar’s therapy was limited to once daily administration of the duxo self-tampons and once a week the duxo-seb spot form, as well as a curative diet with the Analergenic diet.

There are no signs of bacterial infection now, gastrointestinal symptoms are no longer observed, and therapy is just cleansing with duxo swabs (suitable for daily use).

Diagnosis:

Chin furunculosis and suspected food allergy.

Degenerative Mucinotic Mural Folliculitis in cat – first case in Bulgaria

Dr. Ivelina Vacheva, DVM

Central Vet Clinic, Sofia, Bulgaria

ESVD member, BAVD bord member

E-mail: ivchopifcho@yahoo.co.uk

Introduction

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.

Case Study

Mila is an approximately 1,4 years old spayed female cat. She used to be a stray cat, until a lady, regularly

pic 1-1

pic 1-2

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

Pic 2-1

pic 2-2

3-2

3-3

3-4

3-5

3-6

3-7

3-8

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.
Picture 3

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)
Demodicosis; Notoedrosis
Feline atopic syndrome (allergies)
Feline sebaceous adenitis
Dermatophytosis
Degenerative mucinous mural folliculitis
FIV / FeLV
Thymoma-associated exfoliative dermatitis in cats
Lymphoma

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
Bearman: Negative
PCR (antigen) Assays: FCoV, FIV, FeLV, Toxoplasma gondii and Giardia ALL negative.
Skin biopsy: Histopathology results below.
Lymph node biopsy: Histopathology results below.

Therapy

5-2

5-1

5-3

5-4

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)
Histopathological findings:
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)
Histopathological findings:
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”.

6-1

6-3

6-2

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.

7-1

7-2

7-3

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.

8-1

8-2

8-3

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.

9-1

9-2

9-3

9-4

9-5

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.

10-1

10-2

10-3

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.

11-1

11-2

11-3

11-4

11-6

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.

12-1

12-2

12-3

12-4

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.

13-1

13-2

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.

Acknowledgments

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.

REFERENCES:
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 BEAK AND FEATHER DISEASE (PBFD)

Dr Daniela Drumea

Tazyvet

Bucharest, Romania

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.

Clinical presentation:

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.

Differential diagnosis

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).

Diagnosis

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.

A positive PBFD- PCR result has been received.

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

Rare case of Feline Progressive Histiocytic Disease (FPH) – A case report

Dr Giulia Nadasan

Vet Point Vest

Arad, Romania

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

Biological facts:

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.

Epidemiology:

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.

Clinical findings in Chucky :

• 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.

  

  Treatment:

  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.