Generalised scaling in a male donkey Author: Mark CraigEditor: David Lloyd © European Society of Veterinary Dermatology

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


Clinical signs - 1

SignsSigns

• Generalised exfoliative erythroderma

• Thin, depressed

• Rectal temperature, pulse rate, respiratory rate normal

• No peripheral lymphadenopathy

• No oral lesions were present


Clinical signs - 2

SignsSigns

• The donkey is thin and depressed

• There is poor coat with generalised scaling


Clinical signs - 3

SignsSigns

Periocular scaling and greasy matted hair around the eye

Exfoliation and erythema of the scrotum


Clinical signs - 4

SignsSigns

Close up of scaling,matting of coat and

underlying erythema


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


Differential diagnoses

DifferentialsDifferentials

• Bacterial infection including dermatophilosis

• Dermatophytosis

• Pemphigus foliaceus, SLE

• Drug eruption

• Cutaneous lymphoma


Tests - 1

TestsTests

• Skin scrapings

• Blood tests: routine haematological and biochemical screens

• Fungal culture of scale and hairs

• Multiple skin biopsy samples


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


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?


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


Results

TestsTests

An interface dermatitispattern predominated,possible indicating lupus ora drug eruption

Histopathology


What is yourdiagnosis?

TestsTests

• Do the investigations permit a definitive diagnosis?

• Are there any additional investigations which you think may need to be done


Further steps

TestsTests

• Consultation with the pathologist

• The histological picture was not clear and the pathologist suggested a second opinion supported by immunohistochemical studies


Results

TestsTests

Another view of thehistopathology showinglichenoid infiltration andmicroabscess formation withpredominantly mononuclearcells

Histopathology


Diagnosis

TestsTests

• Subsequent immunohistochemical studies showed a strong reaction to CD-3 of infiltrating cells.

• A diagnosis of epidermotropic lymphoma was made


How would you deal with this case?

TherapyTherapy

• What is your prognosis?

• How will you advise the owner?

• What treatment would you consider?


Prognosis

TherapyTherapy

• Prognosis is grave• Disease is fatal• Steroids and cytotoxic drugs are unlikely to be

helpful• Euthanasia was carried out


Review

NotesNotes

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Generalised scaling in a male donkey Author: Mark CraigEditor: David Lloyd © European Society of Veterinary Dermatology