View More View Less
  • 1 Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk 28644, South Korea
  • 2 Department of Veterinary Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, South Korea
Restricted access

Purchase article

USD  $25.00

1 year subscription (Individual Only)

USD  $836.00

Abstract

A 10-year-old, spayed female Shih Tzu dog presented with a history of progressive erythema and multiple crusts developing 85 days previously. The dog had been diagnosed with hyperadrenocorticism (HAC) 55 days prior to presentation and was treated with oral trilostane (2.86 mg/kg, once daily) that was discontinued due to a poor response. In addition to generalised alopecia, erythematous plaques and crusts were noted on the trunk, head and footpads. Lesional impression smears revealed numerous acantholytic cells and non-degenerated neutrophils. Histopathological findings demonstrated subcorneal pustules with acantholytic cells and intact neutrophils. On the basis of these findings, we diagnosed pemphigus foliaceus (PF) with concurrent HAC. We wished to avoid glucocorticoids and, therefore, prescribed oral, once-daily azathioprine (2 mg/kg), modified cyclosporine (7 mg/kg) and ketoconazole (5 mg/kg). By day 71 post-treatment, the erythematous crusts had almost disappeared and the alopecia had improved considerably. However, by the subsequent follow-up examination on day 99, the clinical signs had reappeared due to the tapering of cyclosporine. To the best of our knowledge, this is the first case report describing concurrent PF and HAC in a dog. Combination therapy with azathioprine, modified cyclosporine and ketoconazole was effective, and should be considered for dogs diagnosed with concurrent autoimmune diseases and HAC.

  • Alenza, D. P. and Melián, C. (2017): Hyperadrenocorticism in dogs. In: Ettinger, S. J., Feldman, E. C. and Côté, E. (eds) Textbook of Veterinary Internal Medicine, Vol. 2. 8th ed. Elsevier, Missouri, USA. pp. 17951811.

    • Search Google Scholar
    • Export Citation
  • Arima, K., Higuchi, M., Yoshizawa, S., Horiuchi, T., Nagasawa, K., Nakashima, H., Taniguchi, M. and Niho, Y. (1998): Improvement of systemic lupus erythematosus activity by the association of delayed onset Cushing’s syndrome. J. Rheumatol. 25, 24562458.

    • Search Google Scholar
    • Export Citation
  • Behrend, E. N. (2015): Canine hyperadrenocorticism. In: Feldman, E. C., Nelson, R. W. and Reusch, C. E. (eds) Canine and Feline Endocrinology. 4th ed. Elsevier, Missouri, USA. pp. 377451.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Behrend, E. N., Kooistra, H. S. and Nelson, R. (2013): Diagnosis of spontaneous canine hyperadrenocorticism: 2012 ACVIM consensus statement (small animal). J. Vet. Intern. Med. 27, 12921304.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bizikova, P., Dean, G. A., Hashimoto, T. and Olivry, T. (2012): Cloning and establishment of canine desmocollin-1 as a major autoantigen in canine pemphigus foliaceus. Vet. Immunol. Immunopathol. 149, 197207.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Campbell, S. and Ghosh, S. (2003): Combination immunomodulatory therapy with cyclosporine and azathioprine in corticosteroid-resistant severe ulcerative colitis: the Edinburgh experience of outcome. Dig. Liver Dis. 35, 546551.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Chidgey, M., Brakebusch, C., Gustafsson, E., Cruchley, A., Hail, C., Kirk, S., Merritt, A., North, A., Tselepis, C., Hewitt, J., Byrne, C., Fassler, R. and Garrod, D. (2001): Mice lacking desmocollin 1 show epidermal fragility accompanied by barrier defects and abnormal differentiation. J. Cell Biol. 155, 821832.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gomez, S. M., Morris, D. O., Rosenbaum, M. R. and Goldschmidt, M. H. (2004): Outcome and complications associated with treatment of pemphigus foliaceus in dogs: 43 cases (1994–2000). J. Am. Vet. Med. Assoc. 224, 13121316.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hnilica, K. A. and Patterson, A. P. (2016): Small Animal Dermatology: A Color Atlas and Therapeutic Guide. 4th ed. Elsevier, Missouri, USA. pp. 245301.

    • Search Google Scholar
    • Export Citation
  • Koulu, L., Kusumi, A., Steinberg, M. S., Klaus-Kovtun, V. and Stanley, J. R. (1984): Human autoantibodies against a desmosomal core protein in pemphigus foliaceus. J. Exp. Med. 160, 15091518.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Mueller, R. S., Krebs, I. and Power, H. T. (2006): Pemphigus foliaceus in 91 dogs. J. Am. Anim. Hosp. Assoc. 42, 189196.

  • Olivry, T., LaVoy, A., Dunston, S. M., Brown, R. S., Lennon, E. M., Warren, S. J., Prisayanh, P., Müller, E. J., Suter, M. M. and Dean, G. A. (2006): Desmoglein-1 is a minor autoantigen in dogs with pemphigus foliaceus. Vet. Immunol. Immunopathol. 110, 245255.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Petramala, L., Olmati, F. and Conforti, M. G. (2018): Autoimmune diseases in patients with Cushing’s syndrome after resolution of hypercortisolism: case reports and literature review. Int. J. Endocrinol. 2018, 1464967.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rosenkrantz, W. S. and Aniya J. S. (2007): Cyclosporine, ketoconazole and azathioprine combination therapy in three cases of refractory canine pemphigus foliaceus. North Am. Vet. Dermatol. Forum Proceed. 220, 2007.

    • Search Google Scholar
    • Export Citation
  • Rosenkrantz, W. S., Griffin, C. E. and Barr, R. J. (1989): Clinical evaluation of cyclosporine in animal models with cutaneous immune-mediated disease and epitheliotropic lymphoma. J. Am. Anim. Hosp. Assoc. 25, 377384.

    • Search Google Scholar
    • Export Citation
  • Senécal, J. L., Uthman, I. and Beauregard, H. (1994): Cushing’s disease-induced remission of severe rheumatoid arthritis. Arthritis Rheum. 37, 1826.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Ujiie, I., Ujiie, H., Iwata, H. and Shimizu, H. (2019): Clinical and immunological features of pemphigus relapse. Br. J. Dermatol. 180, 14981505.

  • Vaughan, D. F., Clay Hodgin, E., Hosgood, G. L. and Bernstein, J. A. (2010): Clinical and histopathological features of pemphigus foliaceus with and without eosinophilic infiltrates: a retrospective evaluation of 40 dogs. Vet. Dermatol. 21, 166174.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • White, S. D., Carlotti, D. N. and Pin, D. (2002): Putative drug-related pemphigus foliaceus in four dogs. Vet. Dermatol. 13, 195202.

  • Zur, G. and White, S. D. (2011): Hyperadrenocorticism in 10 dogs with skin lesions as the only presenting clinical signs. J. Am. Anim. Hosp. Assoc. 47, 419427.

    • Crossref
    • Search Google Scholar
    • Export Citation

Monthly Content Usage

Abstract Views Full Text Views PDF Downloads
Jul 2020 0 0 0
Aug 2020 0 0 0
Sep 2020 0 0 0
Oct 2020 0 0 0
Nov 2020 73 3 2
Dec 2020 207 9 3
Jan 2021 49 1 1