Erythema Multiforme Possibly Triggered by Food Substances in a Dog

Eritema multiforme limitado à cavidade oral em um cão: relato de caso

RESUMO O eritema multiforme é uma doença incomum em cães, que afeta pele e mucosas, cuja etiologia ainda não foi completamente elucidada. Contudo, o envolvimento exclusivo da cavidade oral é considerado raro, tendo sido descrito poucas vezes até o presente momento. O objetivo deste trabalho é descrever um caso de eritema multiforme limitado à cavidade oral em um canino. Um cão, fêmea, Akita, com sete anos de idade, apresentou histórico de ulcerações na cavidade oral e nas laterais da língua, sem alterações cutâneas ou sistêmicas. O diagnóstico definitivo foi realizado por meio do exame histopatológico da mucosa oral, e a terapia imunossupressora empregada mostrou-se eficaz. Embora o eritema multiforme seja considerado incomum na espécie canina, este relato de caso apresenta a forma mais rara da doença, com poucos casos descritos em medicina veterinária.

Erythema Multiforme Major in a Dog Treated with Intravenous Human Immunoglobulin and Immunosuppressive Therapy

An ∼12 yr old castrated mixed-breed dog was evaluated for a 7 wk progressive history of intermittent hyporexia, lethargy, and erosive dermatitis. Initial examination revealed disseminated papules and macules coalescing to irregularly shaped and serpiginous plaques with widespread erosion progressing to ulceration. Skin histopathology revealed transepidermal keratinocyte apoptosis with lymphocyte satellitosis and lymphocytic and histiocytic interface infiltrate. Histopathology combined with clinical signs and history were compatible with the diagnosis of erythema multiforme major. Treatment was initiated with multidrug immunosuppression. Following 36 hr with no improvement, intravenous human immunoglobulin (0.45 mg/kg IV) was administered resulting in notable improvement in the dog's attitude and appetite within 2 hr and the dog's skin lesions within 48 hr. Following discharge, the dog improved daily with near complete resolution of dermatologic disease achieved 1 mo postdischarge. All immunosuppressive medications were ultimately discontinued 5 mo following presentation. This is the first report of a dog with erythema multiforme major that has been successfully treated with a combination of intravenous immunoglobulin and immunosuppression.

Cutaneous lupus erythematosus in dogs: a comprehensive review

Since the first description of discoid lupus erythematosus (LE) in two dogs in 1979, the spectrum of canine cutaneous lupus erythematosus (CLE) variants has expanded markedly.

In this review, we first propose an adaptation of the Gilliam-Sontheimer classification of CLE for dogs. We then review the signalment, clinical signs, laboratory and histopathology and treatment outcome of the currently recognized variants of canine CLE, which are vesicular CLE, exfoliative CLE, mucocutaneous LE and facial or generalized discoid LE. We end with a short description of the rare cutaneous manifestations of systemic LE in dogs.

Canine CLE variants are heterogeneous, some of them mirror their human counterparts while others appear—thus far—unique to the dog. As most CLE subtypes seem to have a good prognosis after diagnosis, veterinarians are encouraged to become familiar with the spectrum of often-characteristic and unique clinical signs that would permit an early diagnosis and the rapid implementation of an effective treatment.

[Targeting the skin - erythema multiforme in dogs and cats]

This review article will describe the complex nature of erythema multiforme in dogs and cats. The disease pattern will be illustrated in terms of etiology, pathogenesis, clinical signs, diagnostics and therapy. Erythema multiforme is a rare, immune-mediated skin disorder with an acute specific reaction pattern of skin and mucous membranes against different underlying causes. Reported triggering factors include drugs, food ingredients and neoplasias, but viral or bacterial infections and vaccine reactions were also identified. In over 20% of the cases the cause cannot be identified. The German Shepherd dog and Pembroke Welsh Corgi seem to be predisposed. Erythematous macules, slightly elevated and peripherally spreading papules as well as circular to arciform patterns were described frequently in the dog. Wheals, plaques, vesicles and bullae that develop into ulcers, are also seen. Frequently affected areas in the dog are the ventrum, mucocutaneous junctions, mouth, pinnae and foot pads. Histopathological findings include single cell necrosis in all layers of the epidermis with lymphocytic satellitosis and a cell-poor interface dermatitis. Elimination of the causative factors and concurrent symptomatic therapy are recommended. The prognosis varies from guarded to fair, depending on the underlying cause, presenting clinical signs and response to therapy.

Erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis: a comparative review

BACKGROUND

Human erythema multiforme (EM) and Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) are separate conditions. There is no consensus on classification criteria for the eponymous diseases in animals.

RESULTS

Animal EM is very different from 90% of human EM, which is herpes virus associated (HAEM). Animals lack acrally distributed, typical raised targets. Unlike canine parvovirus 'EM', HAEM is not an active infection. Animal EM is often attributed to drugs, but this is rarely proved. Conversely, human and animal SJS/TEN are almost identical, life-threatening disorders of epidermal necrosis and detachment, typically triggered by drugs (occasionally by infectious agents). Both EM and SJS/TEN are mediated by cytotoxic lymphocyte responses against altered keratinocytes (infectious agents or drugs). Apoptosis results from direct cytotoxicity or through soluble mediators, namely Fas ligand, granzymes, perforin and granulysin. Diagnosis in humans is clinicopathological, with emphasis on clinical lesions; histopathology confirms the pathological process as interface (cytotoxic) dermatitis. Human EM is self-limiting; only recurrent and rare persistent cases require antiviral/immunosuppressive therapies. Drug-induced EM responds to drug withdrawal. Idiopathic canine EM (>40%) is usually chronic, refractory to treatment and may represent heterogeneous conditions. Early identification and removal of the causative drug and high-quality supportive care are critical in SJS/TEN. Mortality rate is nevertheless high.

CONCLUSIONS AND CLINICAL IMPORTANCE

(1) Histopathological lesions do not reliably differentiate EM, SJS and TEN. (2) A multicentre study to develop a consensus set of clinical criteria for EM and SJS/TEN in animals is overdue. (3) No adjunctive therapies, including intravenous immunoglobulin and ciclosporin, have met evidence-based standards.

Erythema multiforme in a ferret (Mustela putorius furo)

Erythema multiforme, an uncommon skin disease resulting from an aberrant immune response, was diagnosed in a domestic ferret (Mustela putorius furo) based on clinical signs and skin biopsies, and this seems to be the first case report of this dermal disease in the ferret. This article discusses treatment and response, and reviews the small animal literature as it relates to disease pathophysiology and treatment.

Immune-mediated interface dermatitis in a rhesus macaque

BACKGROUND

Autoimmune dermatitis, specifically interface dermatitis, is rarely reported in nonhuman primates.

RESULTS AND CONCLUSIONS

This report describes a case of idiopathic immune-mediated dermatitis clinically manifesting as palmoplantar hyperkeratosis in a rhesus macaque, successfully controlled with the use of long-term oral corticosteroid therapy.

Canine parvovirus-2b-associated erythema multiforme in a litter of English Setter dogs

Erythema multiforme (EM) was diagnosed in a litter of English Setter puppies. The puppies developed erythematous cutaneous lesions at the age of 2 weeks. Microscopically, there was individual keratinocyte apoptosis associated with lymphocyte exocytosis in all layers of the epidermis. Intranuclear viral inclusions were seen in multiple tissues and organs. Tissues from the tongue, lymph node, spleen, skin, and small intestine were positive for Canine parvovirus-2 (CPV-2) and negative for Canine distemper virus (CDV) and Canid herpesvirus 1 by fluorescent antibody test. Negative-staining electron microscopy detected parvovirus particles in the intestinal contents. The skin and small intestine were positive for CPV-2b and negative for CDV by polymerase chain reaction. The mucocutaneous junctions and small intestines stained positive for CPV by immunohistochemistry. The present report documents CPV-2b-associated EM in a litter of English Setters and substantiates the single previous report associating EM with CPV-2. The finding suggests that CPV should be considered as a possible cause of EM in dogs.

Diagnosis of Erythema Multiforme Associated with Thymoma in a Dog and Treated with Thymectomy

A 7 yr old Labrador retriever initially presented for severe halitosis, mild ptylism, and depigmentation of the nasal planum. Erythema multiforme was diagnosed based on clinical signs and dermatopathology. Treatment was initiated but the condition did not resolve. Six months later, the dog was diagnosed with a mediastinal mass. Trucut biopsy was performed and histopathologic diagnosis was consistent with a thymoma. A median sternotomy was performed, the thymoma was excised, and the dog recovered well. Four months postoperatively, there were no longer any obvious erythema multiforme lesions and the skin condition was controlled without medication. Erythema multiforme may be a paraneoplastic disorder associated with thymoma in the dog, similar to thymoma-associated exfoliative dermatitis in the cat. Clinical signs of erythema multiforme may warrant performing thoracic radiographs or thoracic CT to rule out thymoma as an underlying cause.