Upload
alexa-daly
View
218
Download
0
Tags:
Embed Size (px)
Citation preview
Dorsal alopecia in a male crossbred dog
Author: Ewan FergusonAuthor: Ewan Ferguson Editor: David LloydEditor: David Lloyd
© European Society of Veterinary Dermatology © European Society of Veterinary Dermatology
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Click to reveal the text on this screen
Click the forward arrow to jump to the next screen
History - 1
HistoryHistory
• Dorsal alopecia and mild pruritus of 9 months duration in a male crossbred dog
• Weight 25 kg
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
History - 2
HistoryHistory
• Mild papular rash on dorsum and ventrum.
• Comedones on dorsum and ventrum.
• Ventral coat thin but skin “normal”
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
History - 3
HistoryHistory
• Coat has become longer and finer in texture in recent months
• Polyuria and polydipsia (3 litres per day) reported
• Good appetite. Poor exercise tolerance
• No previous history of dermatological disease
• 2 cats in the house, both healthy
• Diagnosed by the referring veterinarian as flea allergy dermatitis
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
History - 4
HistoryHistory
• Ectoparasite control• Dog and both cats treated with fipronil (Frontline Spot-
On, Merial) monthly• Home environment treated annually with pyroxyfen
and permethrin spray (Indorex, Virbac)• No improvement
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
History - 5
HistoryHistory
• Pruritus now reported to be controlled with 10 mg prednisolone orally once daily, over the last 4 months
• No hair re-growth seen
• All therapy stopped 2 weeks before referral appointment
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Clinical signs - 1
SignsSigns
The ventral abdominal skin
A few scattered papules, epidermal collarettes & crusts on dorsum & ventrum
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Clinical signs - 2
SignsSigns
Alopecia & hyperpigmentation in dorsal lumbar region
• No visual evidence of ectoparasitism
• Pendulous abdomen & ventral liver lobes palpably enlarged
• Testes normal on palpation
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
How would youapproach this case?
SignsSigns
• What are the next steps you would take?
• Make a list of your principle differential diagnoses
• List any samples you would collect
• List any tests you would perform to assist in making a definitive diagnosis
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Differential diagnoses
DifferentialsDifferentials
• Principle differential diagnoses• Allergy (fleas, atopy, ?food), Hormonal imbalance
including iatrogenic Cushings syndrome, ectoparasitic infestation, dermatophytosis
• Secondary pyoderma, Malassezia dermatitis
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Tests - 1
TestsTests
• Skin scrapings, tape strips, hair plucks and coat brushings - no evidence of ectoparasites or fungi
• Fasted blood sample• Biochemistry: Alkaline phosphatase - 1850 iu/l;
Alanine aminotransferase - 170 iu/l; Glucose - 8.4 mmol/l; Cholesterol - 9.1 mmol/l
• Haematology: Mild mature neutrophilia & eosinopenia
• Urianalysis: Specific gravity - 1.005; No glycosuria
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
What now?
TestsTests
• What are the next steps you would take?
• What are now your principle differential diagnoses?
• Are there any other samples you would collect?
• List any tests you would perform to assist in making a definitive diagnosis
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Tests - 2
TestsTests
• Principal differential diagnosis• Hormonal imbalance particularly natural and
iatrogenic Cushings syndrome• Secondary folliculitis
• Tests• ACTH response test to provide evidence of
possible Cushings syndrome and to identify iatrogenic disease
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Results - 1
TestsTests
ACTH response test
0
100
200
300
400
500
Basal 60 min.
Time
Cortisolnmol/l
What is the significance of this test?
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Results - 2
TestsTests
Low dose dexamethasone suppression test
0
50
100
150
200
250
Basal 3 hours 8 hours
Time
Cortisolnmol/l
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Results - 3
TestsTests
High dose dexamethasone suppression test
0
50100
150
200250
300
Basal 3 hour 8 hour
Time
Cortisolnmol/l
What do these tests tell us?
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
What is yourdiagnosis?
TestsTests
• Do the investigations permit a definitive diagnosis?
• List any additional investigations which you think may need to be done
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Tests - 3
TestsTests
• Radiography• Mass suspected in the left adrenal region
• Ultrasonography• Hypoechoic foci in the liver suggestive of
metastases
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
How would you deal with this case?
TherapyTherapy
• What is your prognosis?
• How will you advise the owner?
• What treatment would you consider?
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Diagnosis
TherapyTherapy
• Hyperadrenocorticism resulting from adrenal neoplasia
• Likely metastasis
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Prognosis
NotesNotes
• Prognosis is guarded• Surgery is not indicated in view of likely metastasis• Medical management with trilstane (Vetoryl,
Arnolds) recommended
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Conclusion
NotesNotes
The owner requested euthanasia. At post mortem examination an adrenal neoplasm and multifocal metastases were demonstrated.
The adrenal tumour can be seen in the centre of the photograph, the kidney is on the left side
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Review
NotesNotes
• If you would like to review this case, please use the navigation buttons below