Internal diseases that have skin lesions

Skin lesions can be associated with many internal diseases. Most organ systems seem to have conditions in which skin lesions can develop. Treatment of the skin lesions in such a situation is palliative. The underlying internal disease must be addressed for resolution of the skin lesions to occur. It is important to view the skin as an integral communicating part of the body and not just as the skin.

Immunity and the endocrine system

In conclusion, interaction between the immune and endocrine systems is highly complex. Generally, abnormalities of T suppressor cells, a result of HLA antigen genetic abnormalities, result in autoimmunity that causes endocrine gland destruction and hormone deficiency, as seen in lymphocytic thyroiditis of dogs, type I DM, hypoparathyroidism, hypoadrenocorticism, and APS. On the other hand, endocrine deficiency (hypothyroidism, DM) or excess (hyperadrenocorticism) states may cause abnormalities of cell-mediated and antibody-associated immunity, leading to susceptibility to a variety of viral, bacterial, and fungal infections. It is hoped that this article sheds some light on the complex and highly integrated endocrine-immune interactions.

Llama dermatology

The purpose of this article is to add information to the many dermatologic topics initially discussed in the 1989 issue on llama medicine (normal anatomy; bacterial, fungal, ectoparasitic, immune-mediated, and zinc-responsive disease) and make mention of newly recognized diseases. Since 1989, it appears that one of the most common and perplexing groups of dermatoses seen at Colorado State University are hyperkeratotic/inflammatory dermatoses. These remain poorly understood. Idiopathic hyperkeratosis (zinc-responsive dermatosis) may be a true zinc deficiency or a keratinizing disorder responsive to supraphysiologic dosages of zinc supplementation. Idiopathic nasal/perioral hyperkeratotic/ inflammatory dermatosis (munge) and idiopathic necrolytic/neutrophilic/hyperkeratotic dermatosis bear clinical, histologic, and therapeutic similarities, and may be subsets of the same disease. Further studies (e.g., looking for metabolic derangements) are necessary to better answer these questions.

[Pemphigus foliaceus in a foal. A case history]

The clinical history, clinical, pathological and immunohistological findings of a four-month-old foal with generalised pemphigus foliaceus are presented. The typical lesions of this autoimmune skin disease are described and discussed.

Detection of antiplatelet antibody with a platelet immunofluorescence assay

An indirect platelet immunofluorescence assay (PIFA) was developed for detection of circulating antiplatelet antibody in dogs with suspected immune-mediated thrombocytopenia (ITP). The PIFA was performed on 10 healthy dogs with normal platelet counts; 76 thrombocytopenic dogs, 20 of which were suspected of having ITP; and 18 dogs with other diseases and normal platelet counts. All normal dogs and negative test results. Fourteen (70%) of 20 dogs suspected of having ITP had positive test results. Fifteen of the remaining 56 thrombocytopenic dogs had positive test results, 9 had cancer and 6 had other immune-mediated diseases including systemic lupus erythematosus (SLE). In this study, the PIFA assay seemed to be more sensitive (70%) than the megakaryocyte immunofluorescence assay (41%) in the diagnosis of ITP. Of the 9 PIFA-positive dogs with neoplasia, 6 had lymphoproliferative disorders. The PIFA was positive in 5 of 18 diseased dogs with normal platelet counts. There was an inverse relationship between the platelet count and the intensity of fluorescence in the PIFA-positive dogs. We conclude that the PIFA is a sensitive screening method for detecting circulating antiplatelet antibody.

Immune-mediated skin disease in the dog and cat

Immune-mediated skin disease was recorded in 24 dogs and 11 cats by the Department of Pathology and Microbiology, University of Bristol, over the period 1973-1992. The clinical and histopathological features, together with the age, breed and sex, are given for each case. Skin biopsies from the 24 dogs in this series, together with tissue from 25 control dogs, were immunostained for IgG, IgM and C3 by direct immunoperoxidase methodology. The same technique, with species-specific antisera for IgG and IgM, was applied to skin biopsies from 10 affected cats. The correlation between clinical features, histopathology and immunohistochemistry is discussed.

Sialadenitis associated with periorbital disease in a dog

Submucosal sialadenitis was diagnosed on histologic examination of a biopsy specimen from a palatine swelling associated with acute, unilateral periorbital disease in a dog. Sialadenitis may have been the cause of periorbital disease or may have been part of a generalized inflammatory condition affecting the periorbital tissues. Corticosteroids were immediately effective in eliminating signs of periorbital disease and sialadenitis. A 3-month corticosteroid treatment was used because the sialadenitis and periorbital disease were immune-mediated. This dog has been free of recurring signs for more than 3 years.

Pemphigus foliaceus in a cat

The author's cat started to develop the signs of pemphigus foliaceus one month after he returned home after six months absence. The initial signs included dry coughing and difficulty with purring and swallowing, followed by typical changes of the skin. The cat was treated by a combination of chrysotherapy and systemic glucocorticoid injections, and remained free of clinical signs for one and a half years. The cat then relapsed and showed the initial signs except that coughing was not observed. It was treated as before but after a second relapse and the same treatment it slowly developed a general weakness and was euthanased.

The relationship between homozygosity and the occurrence of specific diseases in Bouvier Belge des Flandres dogs in The Netherlands

Since purebred dog populations represent closed gene pools, a relatively high level of consanguinity between individuals, and hence of inbreeding, is common. This case control study was conducted to establish the possible connection between the actual level of homozygosity due to inbreeding and specific diseases (flea allergy, osteochondrosis, laryngeal paralysis, neoplasm, autoimmune disease, hypoplastic trachea, and food allergy) occurring in the Bouvier Belge des Flandres breed. One hundred and sixty-eight animals referred to the Utrecht University Clinic formed the patient group. Each of the seven diseases was chosen because of the demonstrability of the diagnosis. Each animal was chosen because one of the selected diseases was established in that individual, and because its pedigree was complete. All dogs of the patient group were born between 1 January 1980 and 31 December 1985. A control group (n = 123) was randomly chosen from the total population of registered Bouviers born in the Netherlands in the same period. pedigree data were obtained from the Dutch Kennel Club. The extent of inbreeding was determined for all animals using Wright's inbreeding coefficient. The distribution of inbreeding coefficients in each patient group was compared with the distribution in controls. Inbreeding coefficients in the control group ranged from 0.0 to 0.406. Animals in which osteochondrosis, food allergy, autoimmune disease, neoplasm, or hypoplastic trachea was diagnosed had higher inbreeding coefficients than controls. It was concluded that in the Bouvier Belge des Flandres dog population examined, the level of homozygosity was positively correlated with occurrence of these diseases.

Gingivitis/stomatitis in cats

Any alteration in the balance of bacterial challenge versus the host's ability to resist and repair will result in oral lesions that are similar in appearance. The bacterial cause of gingivitis and periodontitis in humans and in all other animals in which it has been studied is firmly established, and specific species of predominantly gram-negative anaerobes have been implicated. Naturally occurring or acquired immunopathologies are likely to result in premature dental disease. When oral disease is associated with the accumulation of plaque, a positive response can be achieved by reducing the bacterial challenge to the host through the maintenance of oral hygiene by timely professional dental prophylaxis and home care. Disease that is the result of atypical immune responses, however, can be much more difficult to manage. Such oral disease can occur with either immune deficiencies or exaggerated immune responses, and it is likely that multiple mechanisms are active concurrently. In any case, gram-negative anaerobes present in plaque are likely to be a major contributing factor. Therefore patients with chronic refractory gingivitis-stomatitis must be considered to be plaque intolerant. Only with a frequent regimen of aggressive and thorough professional dental treatment plus meticulous oral home care on a daily basis can one expect to keep these cases in remission. Because this is often unrealistic, the only other way to keep these patients free of disease is by total dental extraction. The tissues that are colonized by the causative organisms must be eliminated. All root tips and bony sequestra must be removed and healing with intact epithelium accomplished before these cases will go into remission. Edentulous feline patients that continue to have signs of gingivostomatitis have been found to have an area of nonhealed bony sequestrum and chronic osteomyelitis. Once effective debridement has been accomplished and epithelial healing completed, nonresponsive cases can be expected to go into remission (Color Plate 2, Figure 7). It is hoped that as more is learned about this frustrating problem, the many factors influencing feline oral disease will be scientifically documented. In the future, actual diagnoses can be systematically made early on in disease, and treatment will be more than just symptomatic.

Investigation of ACTH responses of chickens with autoimmune disease

An altered immunoendocrine feedback regulation within the hypothalamo-pituitary-adrenal axis may modulate the pathogenesis of an avian autoimmune disease. To date studies have been hampered by a lack of reliable, specific, and sensitive methods for determining adrenocorticotropic hormone (ACTH) in chickens. The present study describes the determination of ACTH in plasma of chickens with a commercial radioimmunoassay, the antibody of which binds to the midregion of human ACTH 1-39. The chickens, kept on a 12-hr day and 12-hr night shift with artificial light, showed changes in plasma ACTH concentrations during the light phase with maximum values 8 hr after the light was turned on. ACTH was not measurable after treatment with dexamethasone. Intravenous administration of supernatants from concanavalin A-stimulated spleen cells increased basal plasma ACTH concentrations more than 20-fold within 1 hr. This increase in plasma ACTH was higher and longer lasting in UCD 200 chickens, an animal model for scleroderma, compared with outbred and inbred normal White Leghorn chickens.

Inflammatory oral cavity diseases of the cat

There is a great deal of frustration among veterinarians about the diagnosis and treatment of inflammatory diseases of the oral cavity of the cat. This frustration is due to both the high frequency of feline oral inflammatory lesions and our poor understanding of their causes. This poor understanding can be blamed on several things: (1) a rapidly emerging, but still relatively poor, understanding of feline diseases in general and nutrition in particular; (2) a tendency to lump rather than separate specific oral inflammations; (3) a tendency not to use a thorough and systematic approach to diagnosing oral cavity disease; and (4) the reluctance of veterinarians to apply what is already known about human oral cavity diseases to cats. When problems 2 through 4 are adequately addressed, it becomes apparent that we really know more about oral cavity disease in the cat than we thought we knew and that great progress has been made. The task ahead is to define, in precise medical terms, those remaining disease entities of the oral cavity that pose the greatest health risk to cats, to apply what has been already been discovered from human disease counterparts, and to study them systematically.

Immune-mediated disease as a risk factor for canine lymphoma

BACKGROUND

Autoimmune diseases and neoplasia have been associated as occurring simultaneously in individuals. This study evaluated the association between the simultaneous occurrence of canine lymphoma and various immune-mediated diseases.

METHODS

The Veterinary Medical Data Program, a national disease data registry for veterinary schools, was examined. The following immune-mediated disease categories were evaluated: lupus disorders, pemphigus disorders, autoimmune polyarthritis, immune-mediated hemolytic anemia, and immune-mediated thrombocytopenia. Odds ratios with 99% confidence intervals were calculated for the occurrence of lymphoma and each of the immune-mediated disorder categories.

RESULTS

Only dogs with immune-mediated thrombocytopenia had a statistically significantly increased odds ratio (5.61; 99% confidence interval, 4.16-7.57) for the occurrence of lymphoma versus the general population. This association still was observed for immune-mediated thrombocytopenia when stratified by age, sex, and neutering status.

CONCLUSION

Dogs with immune-mediated thrombocytopenia had a greater occurrence of lymphoma than dogs without immune-mediated thrombocytopenia.

Reversible megaesophagus associated with atypical primary hypoadrenocorticism in a dog

Megaesophagus, hypercalcemia, and eosinophilia associated with glucocorticoid deficiency were detected in a 5-year-old neutered female Standard Poodle with concurrent hypothyroidism. Clinical and biochemical abnormalities resolved with glucocorticoid replacement treatment, and the dog was normal 29 months after diagnosis. The dog's breed and sex and the existence of a second endocrinopathy supported an underlying immunologic disorder.

Demonstration of immunoglobulins and complement in canine and feline autoimmune and non-autoimmune skin diseases with the direct immunofluorescence and indirect immunoperoxidase method

Skin sections from 71 dogs and 10 cats with bullous autoimmune skin diseases and various non-autoimmune dermatopathies were studied for the presence of immunoglobulins (canine IgG, IgM, IgA; feline IgG) and complement (canine C3) using the direct immunofluorescence method (DIF) and the indirect immunoperoxidase method (IIP). In cases of autoimmune skin diseases (9 dogs, 3 cats) both methods were of comparable sensitivity for the detection of epidermal deposits. In canine cases with non-autoimmune dermatopathies, epidermal immunoreactivity was found in 16.1% of cases with the DIF method, and in 29.0% of cases with the IIP method. With both methods, epidermal deposits were most frequently seen in skin sections of dogs with bacterial diseases. Furthermore, positive reactions were found in canine cases with hypersensitivity disorders, endocrine dermatosis, dermatomycosis, parasitic disease, cutaneous Leishmaniasis and in cases with non-specific dermatopathies of uncertain aetiology. In the majority of canine cases intercellular deposits of IgG were found. Immunohistological results should always be interpreted in conjunction with clinical and histomorphological findings in order to establish a diagnosis of autoimmune skin disease and to prevent misdiagnoses.

Immune-mediated disease in the old English sheepdog

Immunological data are reported from 19 cases of immune-mediated disease recorded in the old English sheepdog breed in Western Australia between 1978 and 1989. The conditions included autoimmune haemolytic anaemia (seven), idiopathic thrombocytopenia (one), Evans' syndrome (five), multiple myeloma (two), systemic lupus erythematosus (one), discoid lupus erythematosus (one) and hypothyroidism (two). The most consistent serological findings were raised serum IgG (60 per cent), depressed serum IgM (60 per cent) and the presence of multiple autoantibodies (anti-red blood cell 78 per cent, antinuclear antibody 44 per cent, rheumatoid factor 19 per cent). An underlying, breed-related disorder of immune regulation may account for these observations.

Autoantibodies in pet dogs owned by patients with systemic lupus erythematosus

Systemic lupus erythematosus (SLE) occurs in human beings and in dogs. There is evidence to suggest that the disease is caused by a transmissible factor that may cross the species barrier. We investigated this possibility by looking for autoantibodies and serum protein abnormalities in serum samples from 15 pet dogs owned by patients with SLE and comparing results with those obtained with serum from 10 healthy dogs kept in a controlled environment and 9 dogs with autoimmune diseases. We used standard immunological assays modified for use with canine samples. Compared with the normal dogs, increased amounts of antibody to double-stranded DNA were found in serum from the SLE patients' dogs (median optical density [405 nm] = 0.117 vs 0.299; p = 0.0001), this latter amount being similar to that found in serum from the autoimmune group (0.201; p = 0.6). Abnormal serum protein electrophoresis patterns were found in samples from the autoimmune and SLE patients' dogs but not the normal dogs. These findings support the idea that exposure to common environmental factors or transmissible agents may have a role in causing SLE.

Avian scleroderma: evidence for qualitative and quantitative T cell defects

T cell activation is dependent upon calcium influx and protein kinase C activation, with subsequent lymphocyte proliferation dependent upon IL-2. Abnormalities in T cell proliferation, including abnormal calcium influx and defective protein kinase C activation, have been identified in aged mice and humans and many autoimmune diseases including diabetes, lupus and scleroderma. Since UCD line 200 chickens, which spontaneously develop a scleroderma-like disease, have both thymic defects and a diminished peripheral blood lymphocyte response to IL-2, we have further investigated T cell function in these birds. Interestingly, line 200 T cells respond poorly in vitro to a variety of diversely acting T cell mitogens including concanavalin A, phytohemagglutinin and anti-chicken CD3 monoclonal antibody. Moreover, they do not respond well even to phorbol myristate acetate in conjunction with ionomycin. Addition of exogenous IL-2-containing supernatant concurrently with mitogenic stimulation also had no significant effect. Analysis of intracellular free calcium demonstrated that the lymphocytes from diseased birds had a reduced influx of calcium (or release for intracellular stores) following stimulation. These data clearly reflect a unique defect in T cell activation associated with avian scleroderma. Analysis of chicken CD3, CD4 and CD8 expression revealed a 39% decrease in peripheral blood CD4+ cells in scleroderma birds, although this decrease was not sufficient to explain the 80-90% decrease observed in proliferation assays and calcium influx. Our data support the hypothesis that avian scleroderma is mediated via abnormal function of lymphocyte co-stimulatory molecules or intracellular calcium regulators.

[Autoimmune phenomena during Trypanosoma equiperdum inoculation of the laboratory mouse]

In the course of the Trypanosoma equiperdum-infection of mice an increase of IgM antibodies against the autoantigens dsDNA, keratin and collagen as well as against a protozoan foreign antigen consisting of Sarcocystis gigantea-extract could be observed with a maximum level between 4th and 8th day p. i. The IgG-antibodies did not significantly change during the investigation time. A splenomegaly appeared after the infection. The weight of spleen was four times higher than normal. It was suggested that splenomegaly as well as induction of antibodies against several autoantigens and a foreign antigen were due to a polyclonal activation of lymphocytes.

Investigation of antibodies to extractable nuclear antigens in dogs

Determination of antibodies to specific nuclear antigens, termed extractable nuclear antigen (ENA), was investigated in healthy dogs and in dogs with autoimmune, inflammatory, and neoplastic diseases. Using a counterimmunoelectrophoresis method, the dogs' sera were tested for antibodies against the nuclear antigens single-stranded DNA, Sm, Ro, La, ribonucleoprotein, Scl, and proliferating cell nuclear antigen. Antibodies to the Ro antigen were found in 1 dog with discoid lupus erythematosus, in 1 dog with pemphigus erythematosus, and in 1 dog with facial pyoderma and chronic superficial keratitis. In 15 dogs, antibodies were detected to ENA, but the precipitin lines were too weak to identify the specific ENA. These antibodies were found in some dogs with systemic lupus erythematosus, discoid lupus erythematosus, pemphigus erythematosus, dermatomyositis, vitiligo, lymphoma; in the dog with facial pyoderma and chronic superficial keratitis; and in 1 healthy dog. The highest percentage of dogs with antibodies to ENA in a large series (greater than 8) of this study was in dogs with systemic lupus erythematosus (4 of 13; 31%).

Use of tetracycline and niacinamide for treatment of autoimmune skin disease in 31 dogs

A combination of niacinamide and tetracycline was used to treat 31 dogs with various autoimmune skin diseases (discoid lupus erythematosus, pemphigus foliaceus, pemphigus erythematosus, and bullous pemphigoid). Of the 20 dogs with discoid lupus erythematosus, 70% had excellent or good response to treatment. Serious side effects were not noticed in any dog.

Acupuncture for immune-mediated disorders. Literature review and clinical applications

Acupuncture activates the defense systems. It influences specific and nonspecific cellular and humoral immunities; activates cell proliferation, including blood, reticuloendothelial, and traumatized cells; and activates leucocytosis, microbicidal activity, antibodies, globulin, complement, and interferon. It modulates hypothalamic-pituitary control of the autonomic and neuroendocrine systems, especially microcirculation, response of smooth and striated muscle, and local and general thermoregulation. Immunostimulant points include LI-4, LI-11, ST-36, GB-39, SP-6, GV-14, BL-11, BL-20, BL-23, BL-24, BL-25, BL-26, BL-27, BL-28, and CV-12. Some, such as BL-47, are immunosuppressive. Antifebrile points include GV-14 and ST-36. Reactive reflex SHU points, MU points, and earpoints are useful in organic diseases. In immunomediated diseases, some or all of these points can be used with other points, especially local points and points of the major symptoms or points of the affected body part, area, function, or organ. Applications of acupuncture include treatment of inflammation and trauma; stimulation of tissue healing in burns, ulcers, indolent wounds, ischemia, necrosis, and gangrene; infections; postinfection sequelae; fever; autoimmune disease; allergies; anaphylaxis and shock; and treatment or prevention of side effects from cytotoxic chemotherapy and ionizing radiation. Acupuncture therapy may inhibit neoplastic cells. Examples of acupuncture use in immunomediated conditions in small animals are given.