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DorsalalopeciainamalecrossbreddogAuthor:EwanFergusonEditor:DavidLloydEuropeanSocietyofVeterinaryDermatologyDorsalalopeciainamalecrossbreddogWeight25kgDorsalalopeciaandmildpruritusof9monthsdurationMildpapularrashondorsumandventrum.
Comedonesondorsumandventrum.
Ventralcoatthinbutskin"normal"Historyandpresentingclinicalsigns-1HistoryDorsalalopeciainamalecrossbreddogWeight25kgDorsalalopeciaandmildpruritusof9monthsdurationMildpapularrashondorsumandventrum.
Comedonesondorsumandventrum.
Ventralcoatthinbutskin"normal"ClicktorevealthetextonthisscreenClicktheforwardarrowtojumptothenextscreenCoathasbecomelongerandfinerintextureinrecentmonthsPolyuriaandpolydipsia(3litresperday)reportedGoodappetite.
PoorexercisetoleranceNoprevioushistoryofdermatologicaldisease2catsinthehouse,bothhealthyDiagnosedbythereferringveterinarianasfleaallergydermatitisHistoryandpresentingclinicalsigns-2HistoryCoathasbecomelongerandfinerintextureinrecentmonthsPolyuriaandpolydipsia(3litresperday)reportedGoodappetite.
PoorexercisetoleranceNoprevioushistoryofdermatologicaldisease2catsinthehouse,bothhealthyDiagnosedbythereferringveterinarianasfleaallergydermatitisInitialtherapy-1EctoparasitecontrolDogandbothcatssprayedfortnightlywithdichlorvos+fenitrothionHomeenvironmenttreatedevery2to3monthswithpermethrin+methoprenesprayNoimprovementEctoparasitecontrolDogandbothcatssprayedfortnightlywithdichlorvos+fenitrothionHomeenvironmenttreatedevery2to3monthswithpermethrin+methoprenesprayNoimprovementHistoryInitialtherapy-2Pruritusnowreportedtobecontrolledwith10mgprednisoloneorallyoncedaily,overthelast4monthsNohairre-growthseenAlltherapystopped2weeksbeforereferralappointmentHistoryPruritusnowreportedtobecontrolledwith10mgprednisoloneorallyoncedaily,overthelast4monthsNohairre-growthseenAlltherapystopped2weeksbeforereferralappointmentTheventralabdominalskinClinicalfindingsonreferral-1Afewscatteredpapules,epidermalcollarettes&crustsondorsum&ventrumSignsAfewscatteredpapules,epidermalcollarettes&crustsondorsum&ventrumAlopecia&hyperpigmentationindorsallumbarregionClinicalfindingsonreferral-2NovisualevidenceofectoparasitismPendulousabdomen&ventralliverlobespalpablyenlargedTestesnormalonpalpationSignsNovisualevidenceofectoparasitismPendulousabdomen&ventralliverlobespalpablyenlargedTestesnormalonpalpationHowwouldyouapproachthiscaseWhatarethenextstepsyouwouldtakeMakealistofyourprincipledifferentialdiagnosesListanysamplesyouwouldcollectListanytestsyouwouldperformtoassistinmakingadefinitivediagnosisWhatarethenextstepsyouwouldtakeMakealistofyourprincipledifferentialdiagnosesListanysamplesyouwouldcollectListanytestsyouwouldperformtoassistinmakingadefinitivediagnosisApproachCaseinvestigationPrincipledifferentialdiagnosesAllergy(fleas,atopy,food),HormonalimbalanceincludingiatrogenicCushingssyndrome,ectoparasiticinfestation,dermatophytosisSecondarypyoderma,MalasseziadermatitisSamplesCoatbrushings,deepandsuperficialskinscrapings,tapestrippings,andhairplucks-searchforfleadirt,ectoparasites,dermatophytes,yeastsBiochemistryandhaematologypanels,urinalysisApproachPrincipledifferentialdiagnosesAllergy(fleas,atopy,food),HormonalimbalanceincludingiatrogenicCushingssyndrome,ectoparasiticinfestation,dermatophytosisSecondarypyoderma,MalasseziadermatitisSamplesCoatbrushings,deepandsuperficialskinscrapings,tapestrippings,andhairplucks-searchforfleadirt,ectoparasites,dermatophytes,yeastsBiochemistryandhaematologypanels,urinalysisPreliminaryresultsSkinscrapings,tapestrips,hairplucksandcoatbrushings-noevidenceofectoparasitesorfungiFastedbloodsampleBiochemistry:Alkalinephosphatase-1850iu/l;Alanineaminotransferase-170iu/l;Glucose-8.
4mmol/l;Cholesterol-9.
1mmol/lHaematology:Mildmatureneutrophilia&eosinopeniaUrianalysis:Specificgravity-1.
005;NoglycosuriaTestsSkinscrapings,tapestrips,hairplucksandcoatbrushings-noevidenceofectoparasitesorfungiFastedbloodsampleBiochemistry:Alkalinephosphatase-1850iu/l;Alanineaminotransferase-170iu/l;Glucose-8.
4mmol/l;Cholesterol-9.
1mmol/lHaematology:Mildmatureneutrophilia&eosinopeniaUrianalysis:Specificgravity-1.
005;NoglycosuriaWhatnowWhatarethenextstepsyouwouldtakeWhatarenowyourprincipledifferentialdiagnosesArethereanyothersamplesyouwouldcollectListanytestsyouwouldperformtoassistinmakingadefinitivediagnosisTestsWhatarethenextstepsyouwouldtakeWhatarenowyourprincipledifferentialdiagnosesArethereanyothersamplesyouwouldcollectListanytestsyouwouldperformtoassistinmakingadefinitivediagnosisFurthertestsPrincipaldifferentialdiagnosisHormonalimbalanceparticularlynaturalandiatrogenicCushingssyndromeSecondaryfolliculitisTestsACTHresponsetesttoprovideevidenceofpossibleCushingssyndromeandtoidentifyiatrogenicdiseaseTestsPrincipaldifferentialdiagnosisHormonalimbalanceparticularlynaturalandiatrogenicCushingssyndromeSecondaryfolliculitisTestsACTHresponsetesttoprovideevidenceofpossibleCushingssyndromeandtoidentifyiatrogenicdiseaseResults-1WhatisthesignificanceofthistestTestsWhatisthesignificanceofthistestResults-2TestsResults-3WhatdotheseteststellusTestsWhatdotheseteststellusFurthertestsRadiographyMasssuspectedintheleftadrenalregionUltrasonographyHypoechoicfociintheliversuggestiveofmetastasesTestsRadiographyMasssuspectedintheleftadrenalregionUltrasonographyHypoechoicfociintheliversuggestiveofmetastasesWhatisyourdiagnosisWhatisyourprinciplediagnosisListanyadditionalproblemswhichyouthinkmayneedtreatmentArethereanyotherpossibilitieswhichshouldbeconsideredatthisstageWhatisyourprinciplediagnosisListanyadditionalproblemswhichyouthinkmayneedtreatmentArethereanyotherpossibilitieswhichshouldbeconsideredatthisstageTestsDiagnosisHyperadrenocorticismresultingfromadrenalneoplasiaLikelymetastasisTestsHyperadrenocorticismresultingfromadrenalneoplasiaLikelymetastasisHowwouldyoudealwiththiscaseWhatisyourprognosisHowwillyouadvisetheownerWhattreatmentwouldyouconsiderTreatmentWhatisyourprognosisHowwillyouadvisetheownerWhattreatmentwouldyouconsiderPrognosisPrognosisisguardedSurgeryisnotindicatedinviewoflikelymetastasisMedicalmanagementwithLysodrenrecommendedbutresultsnotpredictableTreatmentPrognosisisguardedSurgeryisnotindicatedinviewoflikelymetastasisMedicalmanagementwithLysodrenrecommendedbutresultsnotpredictableConclusionTheownerrequestedeuthanasia.
Atpost-mortemexaminationanadrenalneoplasmandmultifocalmetastasesweredemonstrated.
Theadrenaltumourcanbeseeninthecentreofthephotograph,thekidneyisontheleftsdeTreatmentTheadrenaltumourcanbeseeninthecentreofthephotograph,thekidneyisontheleftsdeReviewIfyouwouldliketoreviewthiscase,pleaseusethenavigationbuttonsbelowClicktherightmousebuttontonavigateorpress"menu"returntothemainmenuNotesIfyouwouldliketoreviewthiscase,pleaseusethenavigationbuttonsbelowClicktherightmousebuttontonavigateorpress"menu"returntothemainmenu
Comedonesondorsumandventrum.
Ventralcoatthinbutskin"normal"Historyandpresentingclinicalsigns-1HistoryDorsalalopeciainamalecrossbreddogWeight25kgDorsalalopeciaandmildpruritusof9monthsdurationMildpapularrashondorsumandventrum.
Comedonesondorsumandventrum.
Ventralcoatthinbutskin"normal"ClicktorevealthetextonthisscreenClicktheforwardarrowtojumptothenextscreenCoathasbecomelongerandfinerintextureinrecentmonthsPolyuriaandpolydipsia(3litresperday)reportedGoodappetite.
PoorexercisetoleranceNoprevioushistoryofdermatologicaldisease2catsinthehouse,bothhealthyDiagnosedbythereferringveterinarianasfleaallergydermatitisHistoryandpresentingclinicalsigns-2HistoryCoathasbecomelongerandfinerintextureinrecentmonthsPolyuriaandpolydipsia(3litresperday)reportedGoodappetite.
PoorexercisetoleranceNoprevioushistoryofdermatologicaldisease2catsinthehouse,bothhealthyDiagnosedbythereferringveterinarianasfleaallergydermatitisInitialtherapy-1EctoparasitecontrolDogandbothcatssprayedfortnightlywithdichlorvos+fenitrothionHomeenvironmenttreatedevery2to3monthswithpermethrin+methoprenesprayNoimprovementEctoparasitecontrolDogandbothcatssprayedfortnightlywithdichlorvos+fenitrothionHomeenvironmenttreatedevery2to3monthswithpermethrin+methoprenesprayNoimprovementHistoryInitialtherapy-2Pruritusnowreportedtobecontrolledwith10mgprednisoloneorallyoncedaily,overthelast4monthsNohairre-growthseenAlltherapystopped2weeksbeforereferralappointmentHistoryPruritusnowreportedtobecontrolledwith10mgprednisoloneorallyoncedaily,overthelast4monthsNohairre-growthseenAlltherapystopped2weeksbeforereferralappointmentTheventralabdominalskinClinicalfindingsonreferral-1Afewscatteredpapules,epidermalcollarettes&crustsondorsum&ventrumSignsAfewscatteredpapules,epidermalcollarettes&crustsondorsum&ventrumAlopecia&hyperpigmentationindorsallumbarregionClinicalfindingsonreferral-2NovisualevidenceofectoparasitismPendulousabdomen&ventralliverlobespalpablyenlargedTestesnormalonpalpationSignsNovisualevidenceofectoparasitismPendulousabdomen&ventralliverlobespalpablyenlargedTestesnormalonpalpationHowwouldyouapproachthiscaseWhatarethenextstepsyouwouldtakeMakealistofyourprincipledifferentialdiagnosesListanysamplesyouwouldcollectListanytestsyouwouldperformtoassistinmakingadefinitivediagnosisWhatarethenextstepsyouwouldtakeMakealistofyourprincipledifferentialdiagnosesListanysamplesyouwouldcollectListanytestsyouwouldperformtoassistinmakingadefinitivediagnosisApproachCaseinvestigationPrincipledifferentialdiagnosesAllergy(fleas,atopy,food),HormonalimbalanceincludingiatrogenicCushingssyndrome,ectoparasiticinfestation,dermatophytosisSecondarypyoderma,MalasseziadermatitisSamplesCoatbrushings,deepandsuperficialskinscrapings,tapestrippings,andhairplucks-searchforfleadirt,ectoparasites,dermatophytes,yeastsBiochemistryandhaematologypanels,urinalysisApproachPrincipledifferentialdiagnosesAllergy(fleas,atopy,food),HormonalimbalanceincludingiatrogenicCushingssyndrome,ectoparasiticinfestation,dermatophytosisSecondarypyoderma,MalasseziadermatitisSamplesCoatbrushings,deepandsuperficialskinscrapings,tapestrippings,andhairplucks-searchforfleadirt,ectoparasites,dermatophytes,yeastsBiochemistryandhaematologypanels,urinalysisPreliminaryresultsSkinscrapings,tapestrips,hairplucksandcoatbrushings-noevidenceofectoparasitesorfungiFastedbloodsampleBiochemistry:Alkalinephosphatase-1850iu/l;Alanineaminotransferase-170iu/l;Glucose-8.
4mmol/l;Cholesterol-9.
1mmol/lHaematology:Mildmatureneutrophilia&eosinopeniaUrianalysis:Specificgravity-1.
005;NoglycosuriaTestsSkinscrapings,tapestrips,hairplucksandcoatbrushings-noevidenceofectoparasitesorfungiFastedbloodsampleBiochemistry:Alkalinephosphatase-1850iu/l;Alanineaminotransferase-170iu/l;Glucose-8.
4mmol/l;Cholesterol-9.
1mmol/lHaematology:Mildmatureneutrophilia&eosinopeniaUrianalysis:Specificgravity-1.
005;NoglycosuriaWhatnowWhatarethenextstepsyouwouldtakeWhatarenowyourprincipledifferentialdiagnosesArethereanyothersamplesyouwouldcollectListanytestsyouwouldperformtoassistinmakingadefinitivediagnosisTestsWhatarethenextstepsyouwouldtakeWhatarenowyourprincipledifferentialdiagnosesArethereanyothersamplesyouwouldcollectListanytestsyouwouldperformtoassistinmakingadefinitivediagnosisFurthertestsPrincipaldifferentialdiagnosisHormonalimbalanceparticularlynaturalandiatrogenicCushingssyndromeSecondaryfolliculitisTestsACTHresponsetesttoprovideevidenceofpossibleCushingssyndromeandtoidentifyiatrogenicdiseaseTestsPrincipaldifferentialdiagnosisHormonalimbalanceparticularlynaturalandiatrogenicCushingssyndromeSecondaryfolliculitisTestsACTHresponsetesttoprovideevidenceofpossibleCushingssyndromeandtoidentifyiatrogenicdiseaseResults-1WhatisthesignificanceofthistestTestsWhatisthesignificanceofthistestResults-2TestsResults-3WhatdotheseteststellusTestsWhatdotheseteststellusFurthertestsRadiographyMasssuspectedintheleftadrenalregionUltrasonographyHypoechoicfociintheliversuggestiveofmetastasesTestsRadiographyMasssuspectedintheleftadrenalregionUltrasonographyHypoechoicfociintheliversuggestiveofmetastasesWhatisyourdiagnosisWhatisyourprinciplediagnosisListanyadditionalproblemswhichyouthinkmayneedtreatmentArethereanyotherpossibilitieswhichshouldbeconsideredatthisstageWhatisyourprinciplediagnosisListanyadditionalproblemswhichyouthinkmayneedtreatmentArethereanyotherpossibilitieswhichshouldbeconsideredatthisstageTestsDiagnosisHyperadrenocorticismresultingfromadrenalneoplasiaLikelymetastasisTestsHyperadrenocorticismresultingfromadrenalneoplasiaLikelymetastasisHowwouldyoudealwiththiscaseWhatisyourprognosisHowwillyouadvisetheownerWhattreatmentwouldyouconsiderTreatmentWhatisyourprognosisHowwillyouadvisetheownerWhattreatmentwouldyouconsiderPrognosisPrognosisisguardedSurgeryisnotindicatedinviewoflikelymetastasisMedicalmanagementwithLysodrenrecommendedbutresultsnotpredictableTreatmentPrognosisisguardedSurgeryisnotindicatedinviewoflikelymetastasisMedicalmanagementwithLysodrenrecommendedbutresultsnotpredictableConclusionTheownerrequestedeuthanasia.
Atpost-mortemexaminationanadrenalneoplasmandmultifocalmetastasesweredemonstrated.
Theadrenaltumourcanbeseeninthecentreofthephotograph,thekidneyisontheleftsdeTreatmentTheadrenaltumourcanbeseeninthecentreofthephotograph,thekidneyisontheleftsdeReviewIfyouwouldliketoreviewthiscase,pleaseusethenavigationbuttonsbelowClicktherightmousebuttontonavigateorpress"menu"returntothemainmenuNotesIfyouwouldliketoreviewthiscase,pleaseusethenavigationbuttonsbelowClicktherightmousebuttontonavigateorpress"menu"returntothemainmenu
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