Diagnosis of hyperadrenocorticism in dogs: a survey of internists and dermatologists

OBJECTIVE: To determine testing protocols used by board-certified internists and dermatologists for diagnosis of hyperadrenocorticism (HAC) in dogs. DESIGN: Survey. STUDY POPULATION: Board-certified internists and dermatologists. PROCEDURE: A questionnaire was mailed to 501 specialists to gather information pertaining to diagnosis of HAC. RESULTS: 206 surveys were returned. Only 26% of respondents indicated they would screen a dog for HAC if the dog had only a few laboratory abnormalities consistent with HAC and no clinical signs consistent with the disease; 31% indicated they would not, and 43% indicated they would sometimes. Overall, 55% of respondents indicated they preferred to use the low-dose dexamethasone suppression test for routine screening of dogs suspected to have HAC. However, many respondents indicated they would use a different screening test than usual in particular circumstances. Sixty-eight percent of respondents indicated they would perform a second screening test for confirmation if results of an initial screening test were positive but there were few clinical or laboratory abnormalities consistent with HAC. Most respondents used some sort of test to differentiate pituitary-dependent HAC from HAC secondary to an adrenal tumor (AT), but no 1 test was clearly preferred. Ultrasonography was commonly used, whereas computed tomography and magnetic resonance imaging were not, even if available. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that the low-dose dexamethasone suppression test is the test most commonly used to screen dogs for HAC but that other tests may be used in certain circumstances. A variety of tests were used to differentiate pituitary-dependent HAC from HAC secondary to an AT.     

Ocular signs of canine monocytic ehrlichiosis: a retrospective study in dogs from Barcelona, Spain

Canine monocytic ehrlichiosis (CME) is a tick-borne disease caused by the rickettsia Ehrlichia canis. Ocular lesions are a common feature of the disease and can be present in all stages. The purpose of this retrospective study was to determine the prevalence, type and response to treatment of ocular lesions associated with monocytic ehrlichiosis in 46 affected dogs presented to the Autonomous University of Barcelona-Veterinary Teaching Hospital (UAB-VTH) from January 2000 to December 2002. Dogs were included in the study only if they had a positive serologic test for E. canis and information about the clinical outcome was available. Eighteen breeds were represented, with the German Shepherd dog (n = 6) being the most common. There were 25 intact and three castrated males, and 16 intact and two neutered females. Twenty dogs (43.4%) were between 5 and 10 years old. Seventeen dogs (37% of all cases of monocytic ehrlichiosis diagnosed during the study period) had ocular signs, and 11 dogs (64.7% of the ocular cases) had only ocular lesions without apparent systemic signs. Exudative retinal detachment was the most common ocular manifestation; other prevalent findings included anterior exudative uveitis and optic neuritis. Five of the 17 cases with ocular lesions (29.4%) had ocular bleeding disorders (hyphema or retinal hemorrhages). All the dogs with ocular disease presented with bilateral signs. Dogs with posterior segment disease had titers against E. canis that were > or = 1 : 320, while lower titers were noted in dogs with anterior exudative uveitis. Two dogs presented with chronic autoimmune panuveitis after ehrlichiosis treatment. Canine ehrlichiosis should be considered in the differential diagnosis of exudative retinal detachment and anterior uveal inflammatory lesions.     

Ocular and periocular manifestations of leishmaniasis in dogs: 105 cases (1993-1998)

The purpose of this retrospective study was to determine the prevalence, type, and prognosis of ocular lesions associated with leishmaniasis in dogs. One hundred and five dogs (24.4% of all cases of leishmaniasis diagnosed during the study period) had ocular or periocular leishmaniasis, and 16 dogs (15.2% of ocular cases) had only ocular lesions and systemic signs were not apparent. Anterior uveitis was the most common manifestation and other prevalent findings included blepharitis and keratoconjunctivitis. Several distinct variations of eyelid lesions were seen including a dry dermatitis with alopecia, diffuse blepharedema, cutaneous ulceration, and discrete nodular granuloma formation. In some cases with keratoconjunctivitis, corneal lesions clinically resembled nodular granulomatous episclerokeratitis. Twenty-seven of the 34 cases with ocular lesions had improvement in signs following systemic antiprotozoal and topical anti-inflammatory therapy, although many cases with anterior uveitis required long-term topical therapy. Response of ocular signs correlated highly with overall, systemic response to therapy. Ophthalmic manifestations of systemic leishmaniasis are common in the dog, and this disease should be considered in the differential diagnosis of most adnexal and anterior segment ocular inflammatory lesions in dogs in endemic areas.     

Intracranial Lesions in Dogs With Hemangiosarcoma

A retrospective analysis of 85 dogs with hemangiosarcoma (HSA) that underwent complete necropsy, including gross examination of the brain, was conducted. Grossly identifiable intracranial lesions were present in 17 dogs. Twelve of 85 dogs (14.2%) had brain metastases. Four of 85 dogs (4.7%) had hemorrhagic lesions and/or ischemic necrosis without identifiable tumor. One dog had a primary central nervous system tumor. Signs of intracranial disease were present in six of 85 dogs (7.1%) with HSA; four had brain metastases and two had nonneoplastic lesions. Metastases had a propensity for cerebrum and gray matter. Dogs with brain metastases had more widely disseminated disease than dogs without brain metastases (P less than 0.001). Dogs with pulmonary metastases were at greater risk for developing brain metastases than dogs without pulmonary metastases (odds ratio = 8.31). Although thoracic radiography accurately identified ten of 12 dogs (83%) with pulmonary metastases, too few cases were available to assess the applicability/accuracy of thoracic radiography in predicting the presence or absence of brain metastases in dogs with malignancy and signs of intracranial disease.     

Diagnostic efficacy of plasma ACTH-measurement by a chemiluminometric assay in canine hyperadrenocorticism

This retrospective study was performed to investigate the diagnostic efficacy of the chemiluminometric ACTH-measurement to differentiate between pituitary and adrenal dependent hyperadrenocorticism (HAC) in dogs. 49 dogs with pituitary HAC, 10 dogs with adrenal HAC and 1 dog with a combination of both pathologies were included. Dogs with HAC like symptoms, where HAC had been ruled out, served as controls (n = 18). All dogs with adrenal HAC, as well as 9 dogs with pituitary HAC had an ACTH concentration below the detection limit of 2.2 pmol/l (10 pg/dl) plasma. Using 2.2 pmol/l as a cut-off the sensitivity and specificity to diagnose pituitary HAC was 0.82 (95 % CI 0.686 - 0.914) and 1 (95 % CI 0.692 - 1), respectively. With the help of the chemiluminometric assay, a correct classification was possible in 85 % of patients with HAC. As an ACTH-concentration below the detection limit was found in dogs with adrenal as well as pituitary HAC, additional discriminatory tests are necessary in these cases.     

Cardiovascular involvement in 8 dogs with blastomyces dermatitidis infection

BACKGROUND: Blastomycosis is a common systemic fungal infection in dogs. HYPOTHESIS: Dogs with cardiovascular involvement may have abnormalities in electrical conduction and valvular function, and may have a worse prognosis. ANIMALS: Eight client-owned animals. METHODS: Dogs with cardiovascular lesions caused by blastomycosis were identified from retrospective evaluation of medical records. RESULTS: Five dogs had de novo infections and 3 had recurrences of previously treated infections. Harsh labored breathing, lethargy, and anorexia were the most common historic complaints. Three dogs had syncope. Physical examination and clinicopathologic data were typical of blastomycosis and included dyspnea, increased lung sounds, and lethargy. In addition, 3 dogs had heart murmurs and 1 had a third-degree atrioventricular block. Four dogs had myocarditis and 2 had pericarditis or epicarditis. Two dogs had cardiac signs attributed to extracardiac compression by fungal granulomas and clinical signs were relieved by treatment. Half of the remaining 6 dogs were euthanized; 2 of these were not treated. Of the remaining 3 dogs, 1 dog died acutely while sleeping; the second died intraoperatively during an attempt to place an epicardial pacemaker; and the third had Blastomyces-induced endocarditis and died of heart failure. CONCLUSIONS AND CLINICAL IMPORTANCE: Blastomycosis should be considered in the differential diagnosis of dogs from endemic areas with inflammatory myocarditis, heart block, heart base or intracardiac mass lesions, syncope, or endocarditis.     

Serum acute phase protein concentrations in dogs with hyperadrenocorticism with and without concurrent inflammatory conditions

Background: Acute phase proteins (APPs) are promising markers of inflammation in dogs, because they are more sensitive than WBC counts in detecting clinical and subclinical inflammation. Endogenous corticosteroids can mask an acute phase response and make it more difficult to identify underlying inflammatory disease. Objective: The purpose of this study was to evaluate the acute phase protein response in dogs with spontaneous hyperadrenocorticism (HAC) with and without concurrent inflammatory conditions. Methods: Serum concentrations of C‐reactive protein (CRP), haptoglobin (Hp), fibrinogen, and albumin were measured in 44 healthy adult dogs and 39 dogs with HAC; the HAC group was further divided into dogs with and without concurrent infection/inflammation. A fourth group of dogs with severe sepsis and without HAC was compared with the dogs with HAC and severe sepsis. Results: Dogs with uncomplicated HAC had significantly higher Hp and fibrinogen concentrations compared with healthy control dogs (P<.001). Dogs with HAC and severe inflammatory disease also had significantly higher CRP and lower albumin concentrations than control dogs and dogs with HAC without concurrent inflammation. Dogs with sepsis but without HAC had significantly higher CRP concentrations than dogs with HAC and sepsis. Conclusions: Dogs with HAC had increases in the moderate APPs (Hp and fibrinogen), and no significant changes in CRP and albumin compared with healthy dogs. Although concurrent HAC appeared to blunt the CRP response in dogs with sepsis, increased serum CRP concentration in dogs with HAC is likely indicative of severe concurrent inflammation.     

Bilateral cavernous sinus syndrome in dogs: 6 cases (1999-2004)

OBJECTIVE: To determine clinical features, diagnostic imaging abnormalities, underlying disease, disease progression, and outcome in dogs with bilateral cavernous sinus syndrome. DESIGN: Retrospective study. ANIMALS: 6 dogs. PROCEDURE: Dogs were included if clinical signs consistent with bilateral cavernous sinus syndrome (i.e., deficits of the third, fourth, and sixth cranial nerves and at least 1 of the first 2 branches of the fifth cranial nerve) were present and a lesion of the cavernous sinus was identified by means of diagnostic imaging or postmortem examination. RESULTS: 5 dogs were evaluated because of problems referable to abnormal ocular motility or pupillomotor dysfunction, and 1 dog was evaluated because of partial motor seizures involving the face and bilateral mydriasis. Four dogs had neurologic signs referable to an extrasinusoidal lesion at the time of initial examination, and the remaining 2 dogs eventually developed extrasinusoidal signs. Besides neuroanatomic location, the only consistent neuroimaging feature was variably intense, heterogeneous enhancement of cavernous sinus lesions. Neoplasia was histologically confirmed as the underlying cause in 5 of the dogs and was suspected in the remaining dog. Median survival time for the 4 dogs that were treated was 199 days (range, 16 to 392 days). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that bilateral cavernous sinus syndrome is rare in dogs but should be suspected in dogs with compatible clinical signs. Affected dogs have a poor prognosis, and dogs with clinical signs of bilateral cavernous sinus syndrome should be systematically evaluated for neoplastic disease.     

Nasal polyps in dogs: five cases (2005 to 2011)

This series describes five dogs with nasal polyps diagnosed between 2000 and 2011. Clinical signs included reverse sneezing, nasal discharge, epistaxsis, and stertor when breathing. Computerised tomographic findings included soft tissue mass, turbinate destruction, extension through the bony nasal septum and partial lysis of bones surrounding the nasal cavity. Three dogs were treated by dorsal rhinotomy, one dog was treated by ventral rhinotomy, and in one dog the polyp tissue was removed during nasal flushing. Three dogs have no clinical signs of nasal disease. One dog had confirmed recurrence of nasal polyps and was successfully treated with megavoltage radiation. One dog had recurrent nasal disease eight months after dorsal rhinotomy. Nasal polyps are a possible cause of nasal disease in dogs with nasal discharge, epistaxsis and stertor, and a differential diagnosis for dogs with extensive soft tissue lesions of the nasal cavities on computerised tomography. Nasal polyps can be treated successfully by rhinotomy in some cases but may reoccur.     

Canine atopic dermatitis: a retrospective study of 266 cases examined at the University of California, Davis, 1992-1998. Part I. Clinical features and allergy testing results

The medical records of 266 dogs diagnosed as having atopic dermatitis were reviewed. Statistical data were evaluated referable to breed predilections, clinical signs and positive reactions to allergens. Positive reactions were most common to house dust mites (more common with clinical signs in the fall) followed by moulds (more common with clinical signs in the fall and spring). Dogs with positive reactions to moulds, trees or cultivated plants were more likely to have skin and ear yeast infections. Dogs with positive reactions to cultivated plants were more likely to have otitis externa and pedal lesions. Positive reactions to house dust were more common in dogs with early onset of signs and in those tested early in the disease. Dogs had more positive reactions to weeds when allergy tests were performed in the summer and fall. Positive reactions to flea antigen were highly correlated with the clinical diagnosis of flea allergy dermatitis.     

Spirocerca lupi esophageal granulomas in 7 dogs: resolution after treatment with doramectin

Seven dogs with Spirocerca lupi esophageal granulomas were identified based on the site of involvement (ie, distal esophagus) and characteristic endoscopic appearance. Six dogs presented with signs of esophageal disease and 1 dog was asymptomatic. Ova were only identified in the feces of 2 dogs. On thoracic radiographs, 4 dogs had evidence of a caudodorsal mediastinal mass, and 2 of these dogs had spondylitis of midthoracic vertebrae. On endoscopy, single esophageal nodules were observed in 5 dogs, 1 dog had 3 nodules, and 1 dog had 6 nodules. All 7 dogs were treated with doramectin at a dosage of 200 microg/kg SC at 14-day intervals for 3 treatments. Dogs had physical and endoscopic examinations at 2, 4, and 6 weeks after treatment. By 6 weeks, clinical signs had resolved in 6 dogs (1 dog was asymptomatic), and the esophageal nodules had completely resolved in 4 dogs, and incompletely resolved in 3 dogs. Two dogs with incomplete resolution were treated again with doramectin at 500 microg/kg PO daily for an additional 6 weeks. Complete resolution of the esophageal nodules was confirmed by endoscopy in all dogs. Nodules had resolved in 4 dogs by 6 weeks, in 2 dogs by 12 weeks (after 6 weeks additional daily oral therapy), and in 1 dog 22 months after the initial 200 microg/kg treatment regimen. No dog experienced adverse effects to the drug, and all symptomatic dogs have been free of disease for periods ranging from 3 to 4 years.     

Primary seborrhoea in English springer spaniels: A retrospective study of 14 cases

Primary seborrhoea was diagnosed in 14 English springer spaniels over a 17-year period. Seven of the dogs developed clinical signs by two years of age. The dermatosis began as a generalised non-pmritic dry scaling which gradually worsened. Some dogs remained in this dry (seborrhoea sicca) stage, but in most cases the dermatosis became greasy and inflamed (seborrhoea oleosa and seborrhoeic dermatitis). Eight of the dogs suffered from recurrent episodes of superficial or deep bacterial pyoderma. Histological findings in skin biopsy specimens included marked orthokeratotic hyperkeratosis of surface and infundibular epithelium, papillomatosis, parakeratotic capping of the papillae, and superficial perivascular dermatitis in which lymphocytes and mast cells were prominent. The dogs with seborrhoea sicca responded more satisfactorily to therapy with topical emollient-humectant agents or oral omega-3/omega-6 fatty acid supplementation. Dogs with seborrhoea oleosa and seborrhoeic dermatitis did not respond satisfactorily to topical therapy. One dog, however, responded well to etretinate and omega-3/omega-6 fatty acid administration. No dog was cured.     

Pyoderma caused by Pseudomonas aeruginosa infection in dogs: 20 cases

In this report we describe the historical, clinical, histopathological and microbiological features, as well as treatments and clinical outcome, of pyoderma where Pseudomonas aeruginosa alone was isolated on bacterial culture from lesional skin. Twenty dogs were included in this retrospective study. Seven dogs without prior history of systemic or skin disease presented with acute deep pseudomonal pyoderma characterized by a sudden onset of dorsal truncal pain. Skin lesions in these dogs consisted of erythematous papules, haemorrhagic bullae, ulcers and haemorrhagic crusts confined to the dorsum. An excellent clinical response was achieved with 3-4 weeks of treatment with oral fluoroquinolones. Thirteen dogs with a more gradual onset of skin lesions associated with pseudomonal pyoderma had a history of prior skin, ear or systemic disease and had previously been treated with antibiotics and/or immunomodulatory drugs. Skin lesions in these dogs were variable and similar to those described for superficial and deep staphylococcal pyoderma. In this group, one dog was euthanized prior to commencement of treatment, two dogs were lost to follow up, and 9 had resolution of lesions following treatment with topical silver sulfadiazine (one dog), fluoroquinolones (six dogs) or cephalexin (two dogs) administered orally for 3 to 12 weeks. Rod-shaped bacteria were not always detected on cytology. Histopathology of dogs with deep pseudomonal pyoderma was characterized by severe perforating suppurative folliculitis and furunculosis.     

Bone marrow hypoplasia in eight dogs with Sertoli cell tumor

Eight male dogs with Sertoli cell tumor had pancytopenia and bone marrow hypoplasia attributed to endogenous estrogen myelotoxicosis. Clinical signs were hemorrhage caused by thrombocytopenia, anemia caused by blood loss or diminished erythrocyte production, and infection and fever associated with granulocytopenia. Other signs attributed to hyperestrogenism were feminization and prostatic disease. Two dogs recovered after castration and supportive treatment, but 5 other similarly treated dogs died of hematopoietic failure. One dog was euthanatized.     

Signs consistent with syringobulbia may be detected in dogs undergoing MRI

Syringobulbia is a pathologic condition characterized by one or more fluid‐filled cavities within the brainstem. This retrospective case series describes observations in eight dogs with syringobulbia diagnosed during MRI. All dogs were adult, small‐breed dogs with concurrent syringomyelia and neurologic deficits localized to sites rostral to the spinal cord, which cannot be explained by syringomyelia (eg, six dogs had vestibular signs). On MRI, the fluid‐filled cavities had signal intensity characteristics like cerebrospinal fluid, were in the medulla oblongata, and were solitary in each dog. Initially, the shape of the cavity was a slit in five dogs and bulbous in two dogs. Magnetic resonance imaging was repeated in five dogs (6‐55 months of age). One dog had progression of syringobulbia from slit‐like to bulbous, and four dogs had unchanged slit‐like syringobulbia. One dog developed slit‐like syringobulbia after cranioplasty. A variety of medical and surgical treatments were performed with improvement of some but not all clinical signs. One dog died following surgery due to cardiopulmonary failure and the other seven dogs were alive at least 1 year after the initial diagnosis, which was the least time of follow‐up. One surviving dog developed a unilateral hypoglossal nerve deficit 2 months after the initial diagnosis and megaesophagus 14 months later. In conclusion, detecting a fluid‐filled cavity in the medulla oblongata consistent with syringobulbia is possible in dogs undergoing MRI. The cavity is likely acquired, slit‐like or bulbous, progressive, or static, and might be associated with breed size and neurologic signs localized to the medulla oblongata.     

Conjunctival lymphoma: immunophenotype and outcome in five dogs and three cats

Conjunctival lymphoma is well documented in the medical literature, but veterinary reports are few. We report five cases of canine lymphoma, and three of feline in which the presenting sign was conjunctival involvement. All animals were in apparently good health at the time of presentation, and attended the referring clinic because of conjunctival disease. One dog showed generalized lymphadenopathy at presentation, although the ocular lesion was the reason for consultation, but all other patients were well with no detectable disease beyond the eye. All cats were presented for their ocular disease. All dogs were confirmed to have T‐cell tumors, although the histological appearance of these was variable. In contrast, all cats had B‐cell tumors. Referring clinicians and owners were contacted for follow‐up information. Three dogs had been euthanased within 6 months of diagnosis for deterioration of general health. The remaining two were alive and showed no signs of systemic disease. Two cats had good survival following diagnosis, the other died of lesions that may not be related.     

Dermatitis associated with microfilariae (Filarioidea) in 10 dogs

Dermatitis associated with microfilariae of a nematode of the superfamily Filarioidea was diagnosed in 10 dogs from the western United States. Clinically, lesions were single or multiple papules and plaques with alopecia, scarring, erythema, ulceration, or crusting. Eight dogs had lesional pruritus. Microscopically, there was perivascular, periglandular, to interstitial inflammation, with many eosinophils and/or plasma cells, and scarring affecting the dermis and subcutis. Microgranulomas containing microfilaria were seen in six dogs. Microfilariae were noted in microgranulomas or free in the dermis or subcutis, but not in vessels. In one case, an adult female nematode emerged from a biopsy sample that was placed in physiologic saline. Study of this nematode revealed that it was a filarioid of the family Onchocercidae; it was identified as Acanthocheilonema sp. (syn: Dipetalonema ). Antigen tests of five dogs were negative for Dirofilaria immitis . The Knott tests and/or filter tests of nine dogs were negative for microfilariae. An indirect fluorescence antibody test of one dog was also negative for D. immitis . One dog was not evaluated for microfilariae.     

Canine atopic dermatitis: a retrospective study of 169 cases examined at the University of California, Davis, 1992-1998. Part II. Response to hyposensitization

One hundred and sixty-nine dogs were diagnosed with atopic dermatitis, and treated with hyposensitization for at least 1 year based on the results of either intradermal skin tests (IDST) or enzyme-linked immunosorbant serum assays (ELISA). Excellent (i.e. hyposensitization alone controlled clinical signs), good (> 50% improvement), moderate (< 50% improvement) and no (clinical signs were unchanged) responses were seen in 19.5, 32.5, 20.1 and 27.8%, respectively. Age of onset, age when treatment was initiated or the duration of clinical signs had no influence on response to hyposensitization. Dogs having concurrent flea allergy dermatitis were statistically more likely to respond better than dogs with concurrent food allergies. Although not statistically significant, there were trends for Golden Retriever and male dogs to respond better than other breeds and female dogs, respectively. Dogs having more than 21 positive reactions in allergy tests and treated with more than 21 allergens had lower response scores, and a longer time course before achieving beneficial response. Lower response scores were seen in dogs having positive reactions to cultivated plants, grasses, trees or insects. There was no difference in response to hyposensitization whether based on IDST or ELISA results.     

Malignant histiocytosis in Bernese Mountain dogs

Malignant histiocytosis was diagnosed in 10 male and 1 female Bernese Mountain Dogs. Nine of these dogs were closely related. The disease was characterized by a rapidly progressive and inevitably fatal course. Clinical signs varied, but lethargy, anorexia, weight loss, and respiratory and CNS abnormalities predominated. The lungs were the primary site of tumor involvement in 10 dogs. The eleventh dog had lymphadenopathy and severe anemia. Metastatic lesions were detected in all dogs. Anaplastic pulmonary carcinoma was diagnosed originally in 6 of the 11 cases, but this diagnosis was changed to malignant histiocytosis after electron microscopic examination of tissues and immunohistochemical identification of histiocytic markers in the tumor cells.     

Use of cyclosporine to treat granulomatous meningoencephalitis in three dogs

Use of cyclosporine to treat granulomatous meningoencephalitis in three dogs Three dogs with a presumptive diagnosis of granulomatous meningoencephalitis were treated with orally administered cyclosporine. In 2 dogs, cyclosporine administration replaced initial corticosteroid administration, and in 1 dog, cyclosporine was the only treatment used. One dog had the focal form of the disease in the brainstem, 1 dog had the focal form in the forebrain associated with a concurrent ocular form, and 1 dog had the disseminated form of disease. At 12-month follow-up, the 2 dogs with the focal form of the disease had no clinical signs. The dog with the disseminated form improved only partially, and euthanasia was performed 3 weeks after initial evaluation. Cyclosporine was considered effective at an initial dosage of 6 mg/kg (2.7 mg/lb) every 12 hours. Adverse effects associated with cyclosporine administration included transient lymphopenia, excessive shedding, and focal symmetric hair discoloration.