Generalised scaling in a male donkey

1. Generalised scaling ina male donkey Author: Mark Craig Editor: David Lloyd © European Society of Veterinary Dermatology

2. History • 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 Click to reveal the text on this screen Click the forward arrow to jump to the next screen History

3. Clinical signs - 1 • Generalised exfoliative erythroderma • Thin, depressed • Rectal temperature, pulse rate, respiratory rate normal • No peripheral lymphadenopathy • No oral lesions were present Signs

4. Clinical signs - 2 • The donkey is thin and depressed • There is poor coat with generalised scaling Signs

5. Clinical signs - 3 Exfoliation and erythema of the scrotum Periocular scaling and greasy matted hair around the eye Signs

6. Clinical signs - 4 Close up of scaling, matting of coat and underlying erythema Signs

7. How would youapproach this case? • 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 Signs

8. Differential diagnoses • Bacterial infection including dermatophilosis • Dermatophytosis • Pemphigus foliaceus, SLE • Drug eruption • Cutaneous lymphoma Differentials

9. Tests - 1 • Skin scrapings • Blood tests: routine haematological and biochemical screens • Fungal culture of scale and hairs • Multiple skin biopsy samples Tests

10. Tests - 2 • 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 Tests

11. What now? • 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

12. Tests - 3 • 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 Tests

13. Histopathology Results An interface dermatitis pattern predominated, possible indicating lupus or a drug eruption Tests

14. What is yourdiagnosis? • Do the investigations permit a definitive diagnosis? • Are there any additional investigations which you think may need to be done Tests

15. Further steps • Consultation with the pathologist • The histological picture was not clear and the pathologist suggested a second opinion supported by immunohistochemical studies Tests

16. Histopathology Results Another view of the histopathology showing lichenoid infiltration and microabscess formation with predominantly mononuclear cells Tests

17. Diagnosis • Subsequent immunohistochemical studies showed a strong reaction to CD-3 of infiltrating cells. • A diagnosis of epidermotropic lymphoma was made Tests

18. How would you deal with this case? • What is your prognosis? • How will you advise the owner? • What treatment would you consider? Therapy

19. Prognosis • Prognosis is grave • Disease is fatal • Steroids and cytotoxic drugs are unlikely to be helpful • Euthanasia was carried out Therapy

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