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Generalised scaling ina male donkey
Author: Mark CraigAuthor: Mark Craig 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
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History
HistoryHistory
• 10-year-old entire male donkey
• First signs• Reduced appetite, weight loss, generalised scaling• In progress over a 3-month period
• Treatment by referring vet• Intramuscular penicillin/streptomycin daily for 10
days• No improvement
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Clinical signs - 1
SignsSigns
• Generalised exfoliative erythroderma
• Thin, depressed
• Rectal temperature, pulse rate, respiratory rate normal
• No peripheral lymphadenopathy
• No oral lesions were present
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Clinical signs - 2
SignsSigns
• The donkey is thin and depressed
• There is poor coat with generalised scaling
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Clinical signs - 3
SignsSigns
Periocular scaling and greasy matted hair around the eye
Exfoliation and erythema of the scrotum
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Clinical signs - 4
SignsSigns
Close up of scaling,matting of coat and
underlying erythema
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
• Bacterial infection including dermatophilosis
• Dermatophytosis
• Pemphigus foliaceus, SLE
• Drug eruption
• Cutaneous lymphoma
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Tests - 1
TestsTests
• Skin scrapings
• Blood tests: routine haematological and biochemical screens
• Fungal culture of scale and hairs
• Multiple skin biopsy samples
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Tests - 2
TestsTests
• Scrapings did not reveal ectoparasites or fungal structures
• Scales/crusts were emulsified and smears examined for bacteria including Dermatophilus; no significant findings
• Haematology: marked leukocytosis (35.1 x 103/mm3) with neutrophilia and lymphocytosis, slightly reduced RBC count.
• Blood biochemistry: raised total protein, hyperglobulinaemia, raised ALP and CK
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
What now?
TestsTests
• What treatment should you now institute, if any, whilst waiting for the fungal cultures and biopsy results?
• What are now your principle differential diagnoses?
• Are there any other samples you would collect?
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Tests - 3
TestsTests
• No immediate action taken
• No parasites or evidence of dermatophytes demonstrated in scrapings
• Smears failed to reveal significant bacteria
• The leucocytosis (neutrophilia + lymphocytosis) were suggestive of possible bacterial infection but the blood biochemistry results were not diagnostic
• Antibacterial therapy might have been instituted but was inhibited by cost and because no significant deterioration was expected before biopsy results were available
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Results
TestsTests
An interface dermatitispattern predominated,possible indicating lupus ora drug eruption
Histopathology
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
What is yourdiagnosis?
TestsTests
• Do the investigations permit a definitive diagnosis?
• Are there any additional investigations which you think may need to be done
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Further steps
TestsTests
• Consultation with the pathologist
• The histological picture was not clear and the pathologist suggested a second opinion supported by immunohistochemical studies
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Results
TestsTests
Another view of thehistopathology showinglichenoid infiltration andmicroabscess formation withpredominantly mononuclearcells
Histopathology
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Diagnosis
TestsTests
• Subsequent immunohistochemical studies showed a strong reaction to CD-3 of infiltrating cells.
• A diagnosis of epidermotropic lymphoma was made
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
Prognosis
TherapyTherapy
• Prognosis is grave• Disease is fatal• Steroids and cytotoxic drugs are unlikely to be
helpful• Euthanasia was carried out
History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes
Review
NotesNotes
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