Eosinophilic Folliculitis in a Dog

Background: Canine eosinophilic folliculitis is a dermatological disease of acute onset with development of erosive to ulcerative papular lesions, especially on the nasal bridge, that may cause severe skin abnormalities leading to discomfort and pain to the patient. The aim of this report was to characterize a case of a canine eosinophilic folliculitis with papular, ulcerative and crusting dermatitis on the nasal bridge, papules on eyelid and pinna, with confirmed diagnosis based on aspiration cytology, history and response to immunosuppressive therapy with glucocorticoid.Case: A 1-year-old intact Daschund was attended showing an acute onset (over 4 h) of generalized urticarial reaction and nonpruriginous lesion at the muzzle with mild serosanguineous exudate, which persisted for 96 h when the dog was evaluated. It was observed a papular and ulcerative dermatitis with serosanguineous exudate and hematic crusts at nasal bridge, papules measuring 2 mm in diameter in the medial and lateral canthus of the left eyelid, ulcerative papule with hematic crust in the border of left ear pinna, multifocal papules on the skin, dyskeratosis and generalized hair loss. The patient was anesthetized for blood sampling (CBC and serum biochemistry), lesions fine-needle aspiration, scraping and imprint for cytological examination, bacterial culture and nasal turbinates radiography. Fragments for histopathological evaluation were also collected. Erythrogram and platelet evaluation were unremarkable. Leukogram revealed leukocytosis (neutrophilia, lymphocytosis, monocytosis and eosinophilia). Serum biochemistry revealed hyperalbuminemia and discrete hyperproteinemia; values of alanine aminotransferase, creatinine and globulins were within normal range. In cytological examination, intense cellularity was observed with predominance of eosinophils (60%), neutrophils (35%), macrophages performing cytophagocytosis (5%) and degenerated cells. There was no bacterial growth within 48 h after incubation of nasal bridge lesion swab. There were no abnormalities identified at radiographic evaluation of nasal turbinates. As the patient was already with antibiotic therapy and steroidal anti-inflammatory, it was opted to maintain it, since interruption between the day of examination and laboratory results could cause more prejudice than benefit, corticosteroid dose, however, was readjusted (prednisone 2 mg/kg/per os/every 24h). After 1 week of treatment the owner reported significant improvement of clinical signs without any further complaint.Discussion: Typically, type I hypersensitivity reactions such as insect bites do not exceed clinical signs of erythema, local edema and pruritus, with spontaneous remission of clinical signs within few hours after exposure to the antigen. Eosinophilic folliculitis, however, may cause more severe clinical alterations, such as pain, apathy and hyporexia. Nasal bridge is the predominant site described to be affected in cases of eosinophilic folliculitis, being auricular pinna, thorax and limbs considered atypical presentations which can delay proper diagnosis, since in endemic regions for diseases such as visceral leishmaniasis, infectious etiology may be listed first. Differential diagnosis also includes superficial pyoderma, juvenile cellulitis, pemphigus foliaceus and pharmacodermia. The case described in this report emphasize the importance of an accurate diagnosis as well as an early and adequate treatment in order to promote satisfactory response. Also, highlights inadequate use of antimicrobials as a direct consequence of lack of laboratorial investigation.Keywords: skin, eosinophilia, furunculosis, dermatitis, insects

Clinical, Laboratorial and Image Aspects of a Perforated Pyloric Ulcer Secondary to Nonsteroidal Anti-Inflammatory Use in a Cat

Background: Inappropriate use of drugs for veterinary patients represents a common problem at clinical practice. Nonsteroidal anti-inflammatories are one of these misused drugs and may lead to clinical status of challenging diagnosis. Adverse effects for patients submitted to its incorrect use may include simple cases such as pharmacological gastroenteritis to severe acute renal failure or perforated gastroenteric ulcers with no pathognomonic clinical signs. The objective of this report was to describe a case of a perforated pyloric ulcer secondary to prolonged use of meloxicam in a cat with its clinical, laboratorial and image aspects from the moment of suspicion until the diagnosis.Case: An 8-year-old female feline was attended at the Veterinary Hospital of the Dom Bosco Catholic University, with main complaint being a mammary nodule with recent ulceration. Tumor staging and pre-surgical blood analysis were performed previous to total unilateral mastectomy. Eleven days post-surgery the patient was brought for suture removal, but it was observed stupor, moderate dehydration (estimated 10%), 36.7ºC rectal temperature, heart rate at 100 beats/min, respiratory rate at 60 breaths/min, 40 mg/dL blood glucose, icterus and abdominal distension with tympany at percussion (fluid wave test was negative). Anamnesis revealed the possible use of meloxicam for 10 days. The first suspicion was sepsis, with enteric gas secondary to infection. Due to no classical signs of peritoneum effusion and possible severe enteric distension, abdominocentesis was not immediate performed. Complete blood count and serum biochemistry revealed a marked band leukocytosis associated with renal injury, supporting the first sepsis suspicion. Abdominal radiography revealed radiodensity of diffuse aspect at ventral topography but no evidence of marked enteric distension that would justify tympany. Abdominal ultrasound identified effusion predominantly hyperechogenic with hyperechogenic mesentery, indicative of peritonitis. A diagnostic abdominocentesis was performed revealing a dense yellow-green effusion with high suspicion of being gastroenteric liquid. Exploratory laparotomy was not authorized by the owner and the patient was submitted to euthanasia due to the bad prognosis. Macroscopic necropsy was performed and a perforated pyloric ulcer was identified along with an impregnated mesentery with a green-brown color (peritonitis), closing the diagnosis.Discussion: The importance of reiteration regarding veterinary prescription orientation, especially for feline patients, is evidenced. Along the indiscriminate over-the-counter sale of veterinary drugs, self-medication prior to veterinary consultation is usual even for ongoing assisted patients. Considering the unspecific clinical signs that patients with perforated gastroenteric ulcers may present, the diagnosis may be challenging when no complementary image exams are immediate available. The stuporous mental state inhibiting possible manifestation of abdominal discomfort, absence of positive fluid wave test and tympany at percussion which prohibited a secure abdominocentesis could have led to a delay in diagnosis, if not for image support. Considering the emergency status of these patients, early diagnosis is crucial, therefore clinicians should have precaution when approaching patients with possible perforated gastroenteric ulcers and trust clinical history, even when classical signs of abdominal effusion are not present

Feline Eosinophilic Keratoconjunctivitis: Nonsteroidal vs Corticosteroid Topical Treatment

Background: Feline eosinophilic keratoconjunctivitis is a proliferative eye lesion of chronic aspect with usually unilateral presentation that may initiate as a superficial vascularization that evolves to a proliferative, granular, irregular lesion of whitish-pink aspect. With its association with an immune-mediated response, nonsteroidal anti-inflammatories do not appear to be efficient, although few studies describe its use. This case report describes a case of a feline eosinophilic keratoconjunctivitis with its clinical evolution since the use of nonsteroidal topical anti-inflammatory drug in an undiagnosed patient and the transition to a topical corticosteroid and cure after 14 days since diagnosis.Case: An 8-year-old female cat was attended at the Veterinary Hospital of the Dom Bosco Catholic University (UCDB), with main complaint being an eye injury with at least 36 days of evolution andunresponsive to treatment (topical tobramycin 0.3% every 12 h / ketorolac trometamol 0.5%/ every 12 h and ophthalmic lubricant/every 4 h). Since the patient had free access to the street, the owners suspected of trauma-induced lesion. At physical examination, it was observed a proliferative lesion at the peri-limbal superotemporal quadrant of the right cornea with approximately 0.4 cm diameter, with color varying of pale to pink, with irregular surface and low vascularity, the adjacent conjunctiva was also affected with similar multiple nodular lesions (0.1 cm). Fluorescein test was negative as well as FIV/FeLV immunochromatography testing. Feline herpesvirus investigation was not possible. The patient was anesthetized and a lesion specimen was acquired with a cotton swab scraping and a fine needle aspiration. Cytology showed predominance of eosinophils and mast cells, with rare corneal epithelial cells, with smear background containing mast cell granules and free eosinophils. Presumptive diagnosis was eosinophilic keratoconjunctivits. After 14 days of topical corticosteroid (prednisolone acetate 1% every 8 h) the patient showed complete remission of the lesions with no relapse in 48 days.Discussion: Misdiagnosis and consequently mistreatment seems a greater prejudice than the risks associated with sample collection of keratoconjunctival proliferative lesions. Due to the lack of cytobrush or cotton swab, apparently, the reported patient was not submitted to ophthalmic cytology due to reluctance of the staff regarding fine needle aspiration of the cornea lesion. Despite a greater risk of iatrogenic trauma with needle aspiration, with eye anatomy well defined, level size and movement amplitude respected, it is unlikely that severe complications could occur. In this case, the undiagnosed patient was submitted to unnecessary 15 days of topical antibiotic and nonsteroidal anti-inflammatory, and no improvement of the clinical signs was observed. Despite non-recommended, few clinical trials as well as case descriptions are available comparing nonsteroidal and corticosteroid treatment of the disease. Once with diagnosis and beginning of topical prednisolone acetate 1% exclusively, the patient showed continuous improvement until complete remission of clinical signs after 14 days. This report reinforces the recommendation of corticosteroid therapy for feline eosinophilic keratoconjunctivitis and the absence of efficacy of nonsteroidal drugs. It also highlights the importance of diagnosis before any medical treatment is considered

Clinical and Radiographic Aspects of Metacarpal Remodeling Secondary to a Rubber Band (Latex) Compression in a Dog

Background: Musculoskeletal disorders are a common complaint in veterinary small animal casuistic. Along with fractures, degenerative and of carcinogenic etiology are the most frequent and radiographic lesion pattern at these diseases is relative well defined. However, traumatic lesions, considering its innumerous possibilities, may cause unusual clinical and radiographic signs which will delay diagnosis and consequently, adequate treatment. A case of bone osteolysis caused by a compressive trauma by a rubber band is described with its clinical, laboratorial and radiographic aspects.Case: A 2-year-old female dog was attended at the Veterinary Hospital of the Dom Bosco Catholic University (UCDB), with main complaint being an unresponsive to treatment lesion at the left thoracic limb. At physical examination it was observed lameness of the left thoracic limb with an ulcerative lesion at the palmar surface. At the center of the ulcer a 0.3 cm line shaped yellow object was identified, similar to a rubber band. Traction was made and the object distended 5 cm without breaking nor leaving the injury. Showing signs of discomfort, the patient was then sedated for further manipulation. A blood sample for complete blood count and serum biochemistry was collected and radiographic image of the left carpometacarpal-phalangeal region was acquired. Blood analysis revealed moderate thrombocytopenia with an unremarkable serum biochemistry profile (alanine aminotransferase, alkaline phosphatase, creatinine and urea). It was observed metacarpals with increased radiopacity in bone tissue in the mid-diaphysis topography of the II, III, IV and V metacarpal bones, presence of bone remodeling with radiolucent area and slight bone loss (osteolysis) in the mid-diaphysis associated with discrete sclerosis of the medullary cavity of the II, III and V metacarpals. The patient was submitted to surgery and a 3 cm incision was made following the way of the foreign body, with a small traction the object was removed, confirming the presence of a rubber band. Post-surgery prescription included systemic antibiotic, non-steroidal anti-inflammatory, analgesic and topical ointment. Twenty-two days post-surgery, at revaluation, it was observed only discrete improvement of bone remodeling of V metacarpal but with complete wound healing and full recovery of the lameness.Discussion: It was unclear the reason that led to the presence of the rubber band. Unfortunately, the owner could only complaint about at wound that would not heal for weeks. The best hypothesis was the possible use of a beauty accessory after a bathing service. Considering the patient’s long hair, detachment of any accessory to a rubber band base could have gone unnoticed. Definition regarding the time period since the initial trauma would define for how long the compression was necessary to induce metacarpal remodeling, but the presence of the foreign body and consequently, continuous stimulus of inflammation, would not permit a precise definition regarding the time period of the lesion, even if histopathology was authorized. Surgical removal of the rubber band associated with non-steroidal anti-inflammatory, analgesic, systemic and topical antibiotic (ointment) was considered satisfactory, leading to considerable improvement (normal gait) of the nociception and lameness at day three post-intervention and despite persistence of the bone radiographic aspect, full recovery of the skin lesion at day twenty-two