Intraepidermal adenocarcinoma in the perianal skin of two cats, a condition resembling human extramammary Paget's disease

In humans, mammary and extramammary Paget's disease is an uncommon to rare manifestation of intraepidermal adenocarcinoma arising from simple epithelium, usually glandular in origin. This report describes two cats with lesions in perianal skin consisting of atypical intraepidermal neoplastic cells. Differential diagnoses included intraepidermal adenocarcinoma, in situ squamous or basal cell carcinoma, junctional amelanotic melanoma, and epitheliotropic tumours of histiocytic or lymphocytic origin. The atypical intraepidermal cells in the cats were immunohistochemically positive for cytokeratin 8/18 (CK8/18), which stains simple (glandular) epithelium. The keratinocytes and basal cells were negative for CK8/18. In addition, the atypical intraepidermal cells were immunohistochemically negative for melanocytic, lymphocytic, and histiocytic markers. The staining results confirmed the atypical intraepidermal cells to be of simple glandular origin, and ruled out other causes of intraepidermal malignancy. In one cat the clinical lesions consisted of a pruritic erythematous eruption surrounding the anus. Another cat presented clinically for an area of irregular anal thickening; this cat had well-regulated diabetes mellitus. The cats were otherwise clinically healthy. The clinical features, histological appearance, and immunohistochemical staining of the skin lesions were consistent with those described for human perianal extramammary Paget's disease. To the authors' knowledge, this is the first report of an intraepidermal adenocarcinoma in a cat or other animal species.     

Cutaneous xanthomata associated with diabetes mellitus in a cat

A 1,1/2 year-old neutered male cat was presented with a non pruritic skin disease. Pale plaque-like lesions were present on the face, head, axillae and ventral abdomen. Hypercholesterolaemia, hypertriglyceridaemia, hyperglycaemia and glycosuria were all present and histopathological examination confirmed that the skin lesions were xanthomata. A lipoprotein profile revealed an increase in chylomicrons, very low density lipoproteins and low density lipoproteins, and low post heparin lipoprotein lipase activity was present. A diagnosis of diabetes mellitus was made and following treatment with insulin and a change to a low fat, low carbohydrate diet the cat had normal values for blood lipids and glucose and the skin lesions had resolved within a month.     

Eosinophilic papulocrustous dermatitis (miliary dermatitis) and eosinophilic inflammatory bowel disease in two cats

Two cats with chronic eosinophilic skin disease were investigated. The clinical investigation of the skin disease in one cat was limited and inflammatory bowel disease was diagnosed post mortem. A history of weight loss and a palpably thickened bowel in the second cat suggested concurrent gastrointestinal disease. Diagnosis of inflammatory bowel disease was confirmed on biopsy. Treatment with azathioprine and methylprednisolone acetate resolved the signs of gastrointestinal disease, the pruritus and 95% of the skin lesions. The concurrence of eosinophilic papulocrustous dermatitis and eosinophilic bowel disease raises the possibility of their being linked bv a common aetiology or pathophysiology.     

P-60 Hypercalcaemia associated with disseminated Lagenidium spp. infection in a dog: case report

Opportunistic dermatoses can occur in case of immunosuppressive diseases. The first case was a 12-year-old domestic short-haired cat suffering from diabetes with a phaeohyphomycosis due to Scytalidium spp. associated with cutaneous hemangiosarcoma. A painless and ulcerated nodule was observed on a digit with fistulous tracts over the metatarsal joint. Histopathological examination of the nodule revealed a hemangiosarcoma in which brownish fungal colonies were found. Itraconazole (5 mg/kg twice daily), then amputation, allowed 12 months of survival (pulmonary metastases). The second case concerned a 13-year-old Siamese cat with cheyletiellosis associated with spontaneous Cushing's disease and diabetes mellitus. This cat exhibited scales and miliary dermatitis on the trunk associated with polyuria, polydipsia and a pot-belly. Acetate tape impression showed Cheyletiella blakei mites and eggs. Blood analysis revealed diabetes mellitus and spontaneous hyperadrenocorticism. The owner refused treatment. The third case was a 14-year-old domestic short-haired cat with generalized demodicosis associated with iatrogenic Cushing's disease and diabetes mellitus. Long-acting glucocorticoids had been used for treatment of plasma cell stomatitis for 5 years. This cat exhibited erythema, scales, self-induced alopecia, thin skin and moderate pruritus associated with polyuria and polydipsia. Cutaneous lesions principally developed on the abdomen and flanks. Skin scrapings and trichogram showed numerous Demodex cati mites. Routine blood work demonstrated diabetes mellitus and iatrogenic Cushing's disease. Treatment was based on insulin therapy, milbemycin oxime (1 mg/kg once daily) and chlorambucil (0.2 mg/kg once daily). The demodicosis was cured after 4 months, but the cat died of cutaneous and ocular herpesvirus infection 10 months later.
Funding: Self-funded.     

Erythema multiforme possibly triggered by food substances in a dog

A 5-year-old female border collie presented with erythematous skin lesions at the axillae, groin, mucocutaneous junctions, and pinnae. Biopsy revealed lymphocytic interface dermatitis with hydropic degeneration of basal cells and keratinocyte apoptosis. Based on gross and histological features, diagnosis of erythema multiforme was made. The disease was resolved by treatment with azathioprine, prednisolone, and a hypoallergenic diet. Finally, the skin lesion was controlled without drug therapy but recurred easily every time commercial foods except the hypoallergenic diet were used, suggesting that food substances triggered this outbreak.     

Use of human immunoglobulin for treatment of severe erythema multiforme in a cat

A 5-month old female domestic shorthair cat developed lethargy and severe ulcerative skin lesions that covered more than half of its body after routine administration of rabies vaccine, anthelmintic, and ear medication. Clinical and histologic findings were consistent with a severe cutaneous drug reaction or erythema multiforme. The cat's condition continued to deteriorate despite drug withdrawal and supportive care. Administration of human intravenous immunoglobulin was well tolerated by the cat and led to rapid resolution of ulcerative cutaneous lesions, accompanied by substantial improvement in the cat's demeanor within 8 days. Human intravenous immunoglobulin appears to be a novel promising treatment for life-threatening cutaneous drug reactions.     

P‐59 Three cases of opportunistic dermatoses associated with internal diseases in cats

Opportunistic dermatoses can occur in case of immunosuppressive diseases. The first case was a 12‐year‐old domestic short‐haired cat suffering from diabetes with a phaeohyphomycosis due to Scytalidium spp.associated with cutaneous hemangiosarcoma. A painless and ulcerated nodule was observed on a digit with fistulous tracts over the metatarsal joint. Histopathological examination of the nodule revealed a hemangiosarcoma in which brownish fungal colonies were found. Itraconazole (5 mg/kg twice daily), then amputation, allowed 12 months of survival (pulmonary metastases). The second case concerned a 13‐year‐old Siamese cat with cheyletiellosisassociated with spontaneous Cushing's disease and diabetes mellitus. This cat exhibited scales and miliary dermatitis on the trunk associated with polyuria, polydipsia and a pot‐belly. Acetate tape impression showed Cheyletiella blakei mites and eggs. Blood analysis revealed diabetes mellitus and spontaneous hyperadrenocorticism. The owner refused treatment. The third case was a 14‐year‐old domestic short‐haired cat with generalized demodicosis associated with iatrogenic Cushing's disease and diabetes mellitus. Long‐acting glucocorticoids had been used for treatment of plasma cell stomatitis for 5 years. This cat exhibited erythema, scales, self‐induced alopecia, thin skin and moderate pruritus associated with polyuria and polydipsia. Cutaneous lesions principally developed on the abdomen and flanks. Skin scrapings and trichogram showed numerous Demodex cati mites. Routine blood work demonstrated diabetes mellitus and iatrogenic Cushing's disease. Treatment was based on insulin therapy, milbemycin oxime (1 mg/kg once daily) and chlorambucil (0.2 mg/kg once daily). The demodicosis was cured after 4 months, but the cat died of cutaneous and ocular herpesvirus infection 10 months later. Funding: Self‐funded.     

Accidental finding of Hashimoto‐like thyroiditis in male B.U.T. 6 turkeys at slaughter

In the context of a study on the tolerance of rapeseed meal in B.U.T. 6 turkeys, thyroid glands were histologically and immunohistochemically examined because of potential thyreostatic effects. In all groups including the controls with no rapeseed meal in their food, there was a high incidence of lymphocytic infiltration and thyroiditis (14% of thyroids with moderate to severe lymphocytic thyroiditis). Thirty per cent of mononuclear inflammatory cells were immunohistochemically identified as T cells. There were occasional accumulations of PAX‐5 labelled cells, indicating germinal centre development. These lesions resemble Hashimoto's disease in humans. The effect on thyroid function is unknown. Mild hypothyreosis might enhance productivity but also explain dispositions towards diseases seen in context with thyroid dysfunction such as skin diseases (foot pad disease?) and cardiovascular problems. Further studies on thyroid function in these turkeys are needed.     

Diesel oil-induced alopecia in two cats

Two cats were presented for acute onset of rapidly progressive, bilaterally symmetrical hair loss of the ventrum and limbs. Alopecia occurred within 2 weeks after accidental skin exposure to diesel oil. The remaining hair epilated easily in affected areas. Denuded skin was strikingly dry and had adherent scale. Erythema and demarcation between affected and normal skin by a liquid-line were present in one case. Above this line, the hair could not be removed. The head and the footpads were not involved. Systemic signs were not observed. Both cats made a complete recovery without treatment. Histological examination in one cat revealed severe orthokeratotic hyperkeratosis, mild to moderate acanthosis, follicular keratosis, a moderate dermal infiltrate of mast cells and an almost complete absence of sebaceous glands. If skin contact with diesel oil occurs in a cat, thorough washing of skin and haircoat after soaking in prue vegetable oil is recommended.     

Cutaneous granulomas associated with Mycobacterium fortuitum infection in a cat

Feline mycobacterial skin infections are reviewed briefly. A case of skin granulomas in a cat associated with the presence of the fast–growing acid–fast bacillus, Mycobacterium fortuitum , is reported. Surgical excision was followed by recurrence, but resolution of the lesions was obtained by tetracycline therapy for 12 weeks interspersed with a 14–day course of choloramphenicol. An attempt at experimental transmission to a kitten was unsuccessful. The characteristics of the fast–growing mycobacteria and the possible sources of infection are discussed.     

Successful treatment of distichiasis in a cat using transconjunctival electrocautery

A 2-year-old male castrated Domestic Short-haired cat presented to the Ophthalmology Service at the Matthew J. Ryan Veterinary Hospital at the University of Pennsylvania for evaluation of chronic bilateral ocular discharge and blepharospasm. Initial ophthalmic examination revealed severe conjunctivitis and keratitis and the presence of upper eyelid distichiae bilaterally. Initial therapy for suspected feline herpesviral infection provided moderate, but not complete, resolution of the clinical signs. Over the subsequent year, the cat suffered from recurrent, severe, ulcerative keratitis in both eyes despite appropriate medical therapy. Approximately 13 months after the initial presentation, the distichiae were surgically removed using transconjunctival electrocautery, which resulted in complete resolution of the clinical signs. This report documents bilateral distichiasis in a cat, a condition that is considered rare in this species.     

Generalized fatal Cowpox virus infection in a cat with transmission to a human contact case

A 4-month-old female domestic shorthair cat was infected by a virus of the Poxvirus family. The animal developed a severe pneumonia and generalized ulcerating lesions of the skin. Histologically, typical eosinophilic intracytoplasmic inclusion bodies indicative of an Orthopoxvirus (OPV) infection were present. The lung showed grey-white to haemorrhagic nodular lesions with a central zone of complete necrosis of alveolar and bronchial tissue. Electron microscopy from skin and lung nodules revealed typical square-shaped OPV particles. Cultivation of the virus on chorio-allantoic membranes of embryonated chicken eggs resulted in haemorrhagic plaques. Restriction enzyme analysis, PCR and sequencing of the D8L gene identified the OPV isolate as a typical Cowpox virus. It was transmitted by the cat to a human contact person who developed a local nodular dermatitis at the inoculation site in association with signs of general infection and had an increase of OPV-specific neutralizing antibodies in paired serum samples.     

Conjunctival lipid granulomas in a cat

A 12-year-old, neutered male cat was examined because of a persistent serous ocular discharge from the left eye. Three, pale cream, 1-4 mm lesions were detected in the palpebral conjunctivae of the left eye. The surgical excision of the lesions resulted in complete resolution of the epiphora. Histological examination confirmed that the lesions were lipid granulomas but the aetiology and pathogenesis of them were not determined. No disease conditions which result in primary or secondary hyperlipoproteinaemia were detected.     

Dermatophytic pseudomycetomas in four cats

The aim of this retrospective study was to describe the clinical characteristics and treatment of four cats with dermatophytic pseudomycetoma. Four Persian cats, one female and three males, with age ranging from 1.4 to 5 years, were diagnosed with dermatophytic pseudomycetoma by histological examination and fungal culture. Wood's lamp examination revealed positive fluorescence of hairs in all four cats. Characteristic skin lesions consisted of multifocal, raised, firm and nodular to dome-shaped lesions varying in size from 1 to 8 cm in diameter, with ulcers or fistulas in some of the lesions. One cat was treated and cured with 3 months of oral itraconazole; lesions completely regressed, and at the time of writing there has been no recurrence. One cat was treated with surgical excision alone, and recurrence of lesions occurred after a disease-free interval of 15 months. Two cats were treated with surgical excision and systemic itraconazole therapy. Itraconazole therapy was started 1-2 months before surgery and continued for 3 months after surgery. Surgical margins were wide in both cats, and underlying adipose tissue and/or deeper fascia was removed. One cat relapsed, but had a disease-free interval of 18 months. The other cat has been disease free for 32 months. This case series suggests that aggressive, wide surgical excision and concurrent oral itraconazole are highly beneficial in treating dermatophytic pseudomycetoma in cats.     

Equine multisystemic eosinophilic epitheliotropic disease: A case report and review of literature

CASE HISTORY: A 2-year-old Standardbred gelding presented with a history of fever over 1 week, anorexia and skin lesions on all four legs. The lesions were associated with severe pruritus and oedema, and there was no response to therapy.

CLINICAL FINDINGS: The horse was in poor body condition, was lethargic and severely pruritic. Skin lesions consisted of diffuse alopecia and crusting of the distal extremities. Initially it was slightly febrile, but subsequently its temperature increased up to 40°C. Ten days after admission it developed profuse watery diarrhoea and the skin lesions progressed. Skin biopsies revealed superficial and deep perivascular dermatitis with lymphoplasmacytic and eosinophilic predominance. Based on the poor prognosis the horse was subject to euthanasia.

PATHOLOGICAL FINDINGS: The most notable lesions included ulcerative gastritis, typhlitis and colitis with prominent oedema of the intestines, marked subcutaneous oedema and severe thickening of the large bile ducts. Histopathology showed marked eosinophilic and lymphoplasmacytic infiltration of various tissues including the skin, gastrointestinal tract, mesenteric lymph nodes, large bile ducts, pancreatic duct and kidney. Immunohistochemistry revealed a clear predominance of CD3-positive cells in the lymphocytic infiltrations.

DIAGNOSIS: Based on the clinical findings and histopathology a diagnosis of multisystemic eosinophilic epitheliotropic disease (MEED) was made.

CLINICAL RELEVANCE: Multisystemic eosinophilic epitheliotropic disease is rare in horses, and usually chronic. In the current case the horse showed an apparently acute onset with high fever and rapid clinical deterioration. A diagnosis of MEED should be considered in horses presenting with weight loss and skin lesions with or without fever. A final diagnosis is based on histological results of biopsy specimens from affected organs.     

Putative metronidazole neurotoxicosis in a cat

A presumptive case of metronidazole toxicity in a 3.4-kg adult cat is described. The cat had been treated for suspected inflammatory bowel disease with an anti-inflammatory dose of prednisone and metronidazole (73.5-147 mg/kg PO q24h) for approximately 40 days prior to presentation. Clinical signs were primarily related to the central nervous system, including acute tetraparesis, unresponsiveness, tremors, and vocalization. The patient was euthanatized after 12 days of supportive care. Necropsy revealed no significant macroscopic lesions. Histologic evaluation revealed multifocal, fairly well-demarcated foci of necrosis in the brainstem, extending from the diencephalon to the medulla oblongata. To our knowledge, this is the first report to document histologic lesions associated with metronidazole administration in a cat.     

Diagnosis of feline herpesvirus infection by immunohistochemistry, polymerase chain reaction, and in situ hybridization.

An adult domestic shorthair cat had severe chemosis due to purulent and necrotizing blepharitis and conjunctivitis. Purulent rhinitis, necrotizing glossitis, and dermatitis were also diagnosed. The cat was positive for feline immunodeficiency virus and feline leukemia virus. Histologically, intranuclear Cowdry type A inclusions were found within numerous epithelial cells adjacent to the lesions in skin, conjunctiva, and tongue. Electron microscopic examination revealed herpesviral particles within the lesions. Paraffin-embedded skin and tongue tissues were processed in a polymerase chain reaction, using primers to amplify a 306-bp region of the thymidine kinase gene of feline herpesvirus type 1, resulting in a distinct amplification product of the predicted size. The distribution of feline herpesvirus was demonstrated by immunohistochemistry and nonradioactive in situ hybridization. Positive immunostaining was found in nuclei and cytoplasm of numerous epithelial cells within and next to the lesions, whereas in situ hybridization, performed with a digoxigenin-labeled double-stranded DNA probe, revealed hybridization signal only in nuclei of intact epithelial cells. Neither immunohistochemistry nor in situ hybridization showed feline herpesvirus type 1 in tissues of lungs, liver, spleen, intestine, or brain.     

Suppurative granulomatous sinorhinitis associated with Nocardia spp. infection in a cat

A 9-year-old spayed female cat was examined for cheek skin drainage. The skin lesion did not respond to medical therapy; thereafter, facial deformity developed. A computed tomography revealed an intranasal mass and maxillary osteolysis. The mass was histopathologically diagnosed as suppurative granulomatous inflammation caused by filamentous bacteria. The lesion responded well to radiation therapy. Although actinomycosis was suspected histopathologically, no actinomycetes were detected in the nasal lesion by a bacterial culture conducted at a commercial laboratory. The submandibular lymph node and subcutaneous tissue exhibited swelling. Microbiological examination and genetic analysis based on 16S rDNA gene sequence revealed that Nocardia spp. were isolated from both lesions.     

Abnormal skin fragility in a cat with cnolangio-carcinoma

An eight-year-old shorthaired cat which presented with a five-month history of bouts of anorexia and vomiting, developed a large spontaneous skin tear over the left shoulder when manipulated for clinical workup. The cat had no previous history of abnormal skin fragility and clinical examination of the skin revealed a general thinning but no scarring or hyperextensibility. After one day of hospitalisation the animal was euthanased because of its poor condition and on post mortem examination a cholangiocarcinoma with distant metastasis was identified. The skin biopsy specimens obtained from different sites revealed dermal atrophic changes, characterised in electron microscopy by disorganisation in the packing of both collagen fibrils and fibres, and by collagen fibrils with an abnormally wide range of diameters and with an irregular shape in cross section. Although no specific cause of the dermal lesions was suggested, this case differed greatly from the fragile skin conditions previously described in the cat.     

Pets as the main source of two zoonotic species of the Trichophyton mentagrophytes complex in Switzerland, Arthroderma vanbreuseghemii and Arthroderma benhamiae

In cases of highly inflammatory dermatophytosis in humans, it is important to identify the possible source of animal transmission in order to prevent recurrence, family outbreaks or rapidly progressing epidemics. A survey of dermatophytes in pets during a 14-month period in Switzerland revealed, in addition to Microsporum canis , two different species of the Trichophyton mentagrophytes complex, Arthroderma benhamiae and Arthroderma vanbreuseghemii , all causing inflammatory dermatophytoses. Arthroderma benhamiae was only and frequently isolated from guinea pigs. Arthroderma vanbreuseghemii was isolated mainly from European short hair cats, but also from dogs and in one case from a pure-bred cat. Ninety-three percent of the cats carrying A. vanbreuseghemii were hunters and all had skin lesions. In contrast, cats with skin lesions that were strictly indoors were found to be almost exclusively infected by M. canis . Therefore, it can be suspected that infection with A. vanbreuseghemii occurred during hunting and that the natural source of this dermatophyte is either soil or an animal other than the cat, most probably a rodent.