Sterile panniculitis in dogs: new diagnostic findings and alternative treatments

The objective of this study was to analyse the underlying diseases, diagnostic findings and treatment outcomes in 10 dogs with sterile panniculitis. There was no significant breed association in this study (P = 0.86).The median age of the dogs was 7.4 years. Concurrent diseases included atopic dermatitis (four dogs), acute pancreatitis (two dogs) and primary hypoadrenocorticism (one dog), with no concurrent conditions detected in three dogs. There was no significant association with the sterile panniculitis (P = 0.57). Well-circumscribed firm nodules were noted in seven dogs, and ill-defined soft nodules were observed in three dogs. Bacterial and fungal cultures of biopsy samples were negative in all cases. Fine-needle aspiration cytology of the nodules revealed pleomorphic mesenchymal cells in all of the well-circumscribed firm nodules, whereas numerous inflammatory cells and adipose cells were evident in soft nodules. These results indicate that firm nodules in panniculitis could be misdiagnosed as tumours. Immunosuppressive therapy was used in eight cases. Topical dexamethasone was used in four dogs, intralesional dexamethasone in one dog, oral prednisolone plus ciclosporin in two dogs and oral prednisolone only in one dog. The remaining treatments were surgical excision and systemic cefalexin in one dog each. The lesions regressed within 1 week in all cases, with more rapid remission following systemic immunosuppressive therapy. This study suggests that cytology may be misinterpreted as neoplastic, especially with firm lesions. In addition, topical glucocorticoid therapy should be further evaluated as a potential treatment for canine sterile panniculitis.     

A retrospective study and gene analysis of canine sterile panniculitis

In this study, a retrospective analysis was conducted to assess the current aspects and predisposing factors of canine sterile panniculitis. Miniature dachshund, neutered, and younger dogs appeared to be predisposed. In addition, histories of previous surgery and injection were associated in 46.5% of the cases, with several types of surgical suture materials used. About 88% of the dogs had multifocal lesions, frequently with signs of systemic illnesses. Whereas systemic immunosuppressive therapy was effective in most dogs, surgical excision of lesions was rarely curative. In order to prevent recurrences, over 65% of the cases required prolonged immunosuppressive therapy. Polymorphism of canine alpha(1)AT gene was investigated as a candidate gene for sterile panniculitis. Eight polymorphisms were discovered in seven Miniature dachshunds by direct nucleotide sequencing, which included a 12-bp deletion, three non-synonymous single nucleotide polymorphisms, and four silent substitutions. Genotyping of the two polymorphisms, c.109_120del12 and c.483A>C, which identified at high incidence in the dachshunds, was conducted in 83 dogs of 6 popular breeds. The frequencies of neither polymorphism differed between Miniature dachshunds and other breeds, suggesting that neither is responsible for developing panniculitis.     

Chronic nodular panniculitis in a three-year-old mare

The clinical signs of chronic nodular panniculitis in a three-year-old mare were consistent with a diagnosis of sterile nodular panniculitis, but the mare had histopathological signs of both generalised steatitis and sterile nodular panniculitis. The mare was deficient in vitamin E and selenium.     

Sterile idiopathic pedal panniculitis in the German shepherd dog - clinical presentation and response to treatment of four cases

Four cases of sterile idiopathic pedal panniculitis are described in the German shepherd dog. All the dogs presented with characteristic clinical signs of localised panniculitis dorsal to the midline of the carpal or tarsal pads of one or more legs. Diagnostic procedures did not identify a cause for the panniculitis and none of the cases had a history of penetrating foreign bodies. All cases failed to respond to antibiotic therapy but did respond to anti-inflammatory doses of prednisolone. The lesions in three dogs relapsed once the levels of steroids were reduced. However, in two of the cases oral vitamin E therapy at a dose of 300 iu twice daily acted in a steroid sparing capacity. In a fourth case, vitamin E acted to control the clinical signs without steroid therapy.     

Unusual systemic signs in a dog with sterile neutrophilic-macrophagic lymphadenitis and nodular panniculitis

A 7 mo old female English springer spaniel was presented with diarrhea, vomiting, apathy, and hyperthermia. Further examinations revealed generalized lymphadenomegaly consistent with sterile neutrophilic-macrophagic lymphadenitis and pulmonary involvement. Subcutaneous nodules developed one day after presentation. Histology was consistent with sterile idiopathic nodular panniculitis and vasculitis. No infectious organism was isolated. The dog responded to prednisolone, but relapsed during medication tapering. Cyclosporine had to be added to control the disease. No further relapse had occurred 98 wk after the first presentation. This is an unusual presentation of a systemic sterile neutrophilic-macrophagic lymphadenitis with nodular panniculitis and vasculitis associated with gastrointestinal and pulmonary signs.     

Sterile nodular dermatitis in dogs.

The types of canine sterile nodular dermatitis discussed in this article have in common the clinical presentation of nodules or plaques; however, they differ in many aspects such as breed predilection, distribution and evolution of cutaneous lesions, systemic involvement, response to therapy, and prognosis. The definitive diagnosis should be based on multiple skin biopsy results. Other ancillary tests may be indicated in cases of systemic involvement. In addition, serum alpha1 antitrypsin can be measured to demonstrate the association between nodular panniculitis and serum alpha1 antitrypsin deficiency. A better understanding of the etiopathogenesis of each of these interesting skin conditions necessitates extensive and systematic diagnostic approaches.     

Mycobacterium goodii infection in a dog with concurrent hyperadrenocorticism

Abstract A 9-year-old Boston terrier was diagnosed with multifocal, nodular panniculitis caused by an organism belonging to the Mycobacterium smegmatis group by histological evaluation and bacteriological identification. The mycobacterial species was identified by direct gene sequence analysis and confirmed to be Mycobacterium goodii. Treatment using doxycycline and ciprofloxacin was successfully implemented for the mycobacterial panniculitis over a period of 9 months. Concurrent pituitary-dependent hyperadrenocorticism (Cushing's disease) was also identified using routine diagnostic methods and mitotane therapy was implemented. There was follow-up for 14 months after cessation of antimicrobial therapy with no recurrence of mycobacterial infection. Although cutaneous infections are frequently recognized as complications of canine pituitary-dependent hyperadrenocorticism, concurrent mycobacterial panniculitis due to any rapidly growing mycobacterium has not previously been reported. This is the first confirmed case of mycobacterial panniculitis due to M. goodii infection in a dog and also the first of any rapidly growing mycobacterial infection in a dog with concurrent endogenous Cushing's disease.     

Panniculitis associated with pancreatic necrosis in a dog

A seven-year-old male labrador cross was presented with lethargy, pyrexia and multiple nonpruritic draining skin lesions. The dog had sterile nodular panniculitis which, at necropsy, was found to be associated with a bile duct carcinoma leading to pancreatic necrosis.     

Sterile nodular panniculitis and pansteatitis in three weimaraners

The clinical and pathological findings in three unrelated weimaraners with pyrexia and multiple subcutaneous nodules are reported. Abdominal pain was an additional feature in two of the dogs and clinical investigations revealed inflammation of subcutaneous, mesenteric and falciform fat. Histopathological findings were consistent with pansteatitis. In the third dog, lesions were apparently limited to the subcutis and, hence, a diagnosis of nodular panniculitis was made. Microbiological examination of tissues was negative in all dogs, and there was no evidence of pancreatic disease. This report thus describes a presumed sterile and idiopathic panniculitis/pansteatitis complex in weimaraner dogs. Although the aetiology is unknown, this may represent an immune-mediated disorder.     

A self-limited acute febrile sterile neutrophilic dermatosis (Sweet's-like syndrome) in a dog featuring target skin lesions with strong upregulation of interleukin-8 and T-helper 1 pathway

In this report, we provide a case of self-limiting canine acute febrile sterile neutrophilic dermatosis in which the clinical signs featured typical target skin lesions with strong upregulation of T-helper 1 markers and interleukin-8, a potent neutrophil chemoattractant. Further, large case series are needed to characterize canine sterile neutrophilic dermatosis.     

Cytologic diagnosis of generalized cutaneous sporotrichosis in a hunting hound

A 1-year-old male Foxhound/Walker Hound mix was presented to the small animal internal medicine service at Louisiana State University School of Veterinary Medicine with a 6-week history of progressive, multifocal, ulcerative and draining, well-circumscribed lesions in a generalized distribution. Prior to referral, a presumptive diagnosis was made of sterile pyogranulomatous disease; immunosuppressive therapy was instituted but resulted in clinical deterioration. At presentation, the dog had marked neutropenia (1100 neutrophils/microL), and a mild toxic left shift (400 bands/microL). Cytologic findings in the exudates from a draining skin lesion included high numbers of markedly degenerate neutrophils (about 95% of nucleated cells) as well as low numbers of macrophages, small mature lymphocytes, and eosinophils. Low numbers of intracellular (within neutrophils and macrophages) and extracellular, pleomorphic, cigar-to-ovoid shaped organisms ( approximately 3x9 microm) consistent with Sporothrix were observed. Histopathologic examination of a skin biopsy showed marked, chronic, active, ulcerative, pyogranulomatous dermatitis and panniculitis, with intralesional yeast consistent with Sporothrix sp. The etiologic agent was confirmed as Sporothrix schenckii by macerated tissue fungal culture. The patient was treated with itraconazole, enrofloxacin, and clindamycin, with clinical resolution occurring over a 3-month period. This case is a rare example of the cytologic diagnosis of Sporothrix schenckii in a canine patient. Diagnosis of canine sporotrichosis is often challenging and usually requires tissue culture, as infected dogs typically harbor very few organisms. The patient's prior immunosuppressive therapy likely contributed to higher numbers of organisms in exudates from the cutaneous lesions, facilitating cytologic diagnosis.     

The ACVD task force on canine atopic dermatitis (XXII): nonsteroidal anti-inflammatory pharmacotherapy.

The pharmacotherapy of canine atopic dermatitis has relied primarily on the use of glucocorticoids and anti-histamines. During the last decade, other anti-inflammatory drugs have been investigated in clinical trials. This paper will review the studies using misoprostol, cyclosporine, tacrolimus, phosphodiesterase inhibitors, capsaicin, leukotriene inhibitors and serotonin-reuptake inhibitors for treatment of dogs with atopic dermatitis. For each drug the mechanism of action, the rationale for use in atopic dermatitis, the clinical efficacy, reported adverse effects and strength of recommendation for treatment of canine atopic dermatitis are described. At the time of this writing, there is fair evidence to support the recommendation for using cyclosporine, misoprostol and pentoxifylline for treatment of canine atopic dermatitis. This recommendation can be strengthened by the performance of additional blinded randomized controlled trials with larger number of dogs. In contrast, there is insufficient evidence to recommend for or against treatment with tacrolimus, leukotriene inhibitors, serotonin-reuptake antagonists and capsaicin.     

Treatment of localized lesions of canine atopic dermatitis with tacrolimus ointment: a blinded randomized controlled trial

This investigator-blinded randomized controlled trial was designed to determine whether tacrolimus ointment (Protopic, Fujisawa Healthcare) decreased the severity of localized lesions of canine atopic dermatitis (AD). Twenty dogs with AD were enrolled if they exhibited lesions on both front metacarpi. Each foot was randomized to be treated with 0.1% tacrolimus or placebo (vaseline) ointment twice daily for 6 weeks. Before, and every 2 weeks during the study, erythema, lichenification, oozing and excoriations each were graded on a 10-point scale (maximal total score: 40). The primary outcome measures were the percentage reduction from baseline of lesional scores and the number of subjects whose scores had decreased by 50% or greater at study end. Intention-to-treat analyses were used. At study onset, lesional scores were not significantly different between sites treated with tacrolimus or placebo. After 6 weeks, the percentage reduction from baseline scores was higher for tacrolimus-treated sites (median: 63%; 95% confidence interval: 39-67) than for placebo-treated feet (median: 3%; confidence interval: -2-13) (Wilcoxon test; P = 0.0003). When tacrolimus was applied, lesions decreased by 50% or greater in 15/20 dogs (75%); these dogs were those that completed the study. In contrast, this benchmark was not reached for any placebo-treated feet (Fisher's test; P < 0.0001). Adverse drug events consisted of minor irritation in some lesional areas treated with tacrolimus. Results of this trial suggest that the application of 0.1% tacrolimus ointment is useful for reducing the severity of localized skin lesions of canine AD.     

Safety and tolerability of 0.1% tacrolimus solution applied to the external ear canals of atopic beagle dogs without otitis

Tacrolimus is a nonsteroidal alternative to treat noninfectious otitis externa (OE) in people. This 21‐day study investigated whether twice daily application (0.2 mL/dose) of sterile olive oil based 0.1% tacrolimus suspension in ears of atopic beagle dogs without OE was associated with adverse local reactions, development of OE, change in otic cytology, vestibular dysfunction, or hearing loss detected by brainstem auditory evoked response (BAER). The study was randomized, double‐blinded, and placebo‐controlled. Twenty‐two dogs matched for age and sex were randomized to tacrolimus or vehicle control treatment groups. Two investigators independently evaluated dogs for signs of adverse effects including OE the first 4 days of treatment, then every 3 days. A logistic regression model was fit for each investigator’s clinical scores (SAS, 9.2, 2008). Time (P = 0.0032) and group (P = 0.0167) were always significant for OE. Inter‐observer reliability of clinical scores was strong, measured using Kappa coefficients and proportion of agreement. All nine exclusions (7/10 control‐ and 2/12 tacrolimus‐treated dogs) were excluded for yeast OE. Inter‐observer agreement to exclude was 100%. All dogs not excluded had normal BAER assessments before treatment, weekly during treatment, and after 21 days of treatment. None showed vestibular abnormalities at these times. Tacrolimus blood concentrations (Abbott IMx Tacrolimus II) were below detection limits (3 ng/mL) at baseline and after 21 days of treatment. Results suggest otic application of olive oil based tacrolimus suspension to canine ears with intact tympanic membranes is unlikely to result in hearing loss or vestibular dysfunction but yeast OE is a possible risk.     

Panniculitis, polyarthritis and osteomyelitis associated with pancreatic neoplasia in two dogs

A 12-year-old crossbred dog (case 1) and a 12-year-old Shetland sheepdog (case 2) were presented with a history of lameness and distal limb swelling. Physical examination revealed joint effusions and asymmetrical swellings of the extremities. In case 1, a diagnosis of arthritis and cellulitis was made on fine-needle aspiration biopsy of the synovium and subcutis. In case 2, bone biopsies and synovial aspirates diagnosed osteomyelitis and arthritis. A diagnosis of pancreatic disease was made on the findings of marked elevations of serum lipase concentrations and ultrasonographic identification of pancreatic masses in both cases. Both the cases were non-responsive to symptomatic management and were subsequently euthanased. Postmortem examination confirmed the diagnosis of panniculitis, arthritis and osteomyelitis in both cases. A pancreatic exocrine adenoma was identified in case 1 and a pancreatic adenocarcinoma with widespread metastases in case 2. To the authors' knowledge the association of panniculitis, polyarthritis and osteomyelitis with pancreatic disorders has not been reported previously in canine clinical cases.     

Dirofilaria repens—An etiological factor or an incidental finding in cytologic and histopathologic biopsies from dogs

Dirofilaria repens is an endemic, zoonotic parasite of carnivores, causing subcutaneous dirofilariasis, which is mostly asymptomatic. The aim of this study was to describe 22 cases of canine subcutaneous dirofilariasis. The cytologic and histopathologic samples were collected from dogs, which presented with various clinical signs such as cutaneous/subcutaneous nodules, hydropericardium, ascites, and lymphadenomegaly. The cytologic or histopathologic examination revealed purulent, pyogranulomatous, granulomatous or eosinophilic dermatitis/panniculitis, and the presence of D repens microfilariae or adults. The microfilariae or adults were also found incidentally in neoplastic cutaneous or subcutaneous tumors and in a sialocele. For the first time, microfilariae were also detected and described in pericardial and abdominal effusions and in enlarged reactive lymph nodes. Although it is well known that D repens can cause dermatitis and panniculitis in dogs, no previous reports of D repens microfilariae in body cavity fluids were found. The role of this parasite in the accumulation of body cavity fluid or in reactive lymphadenomegaly requires further investigation. Due to its zoonotic potential, and apparently underestimated pathogenicity, each case of canine subcutaneous dirofilariasis should be treated.     

P‐48 Treatment of localized lesions of canine atopic dermatitis with tacrolimus ointment: a blinded,randomized, controlled trial

The purpose of this study was to determine whether tacrolimus ointment (Protopic) decreased the severity of localized lesions of canine atopic dermatitis (AD). Twenty dogs with AD were enrolled if they exhibited skin lesions localized to both front metacarpi. Each foot was randomized to be treated either with 0.1% tacrolimus or placebo (vaseline) ointment twice daily for 6 weeks. The nature of treatment for each foot lesion was concealed from the clinician. Before, and every 2 weeks during the study, erythema, lichenification, oozing and excoriations each were graded on a 10‐point scale (maximal total score: 40). The primary outcome measures consisted of the percentage reduction from baseline of lesional scores, and the number of subjects whose scores had decreased by 50% or greater by the end of the study. Intent‐to‐treat analyses were used. At the beginning of the study, lesional scores were not significantly different between treatment groups. After 6 weeks, the percentage reduction from baseline scores was higher for tacrolimus‐treated sites [median: 63% (95% CI: 39–67)] than for placebo‐treated feet [3% (‐2‐13)] (paired t‐test; P < 0.0001). When tacrolimus was applied, lesions decreased by 50% or greater in 15 dogs (75%), while this benchmark was not reached for any placebo‐treated feet (Fisher's exact test; P < 0.0001). Adverse drug events consisted of minor irritation in some dogs treated with tacrolimus. Results of this randomized, controlled trial suggest that the daily application of 0.1% tacrolimus ointment is useful for reducing the severity of localized skin lesions of canine AD. Funding: Self‐funded.     

P-49 Pemphigus foliaceus confined to the nails in a Hungarian short-haired pointer

The purpose of this study was to determine whether tacrolimus ointment (Protopic) decreased the severity of localized lesions of canine atopic dermatitis (AD). Twenty dogs with AD were enrolled if they exhibited skin lesions localized to both front metacarpi. Each foot was randomized to be treated either with 0.1% tacrolimus or placebo (vaseline) ointment twice daily for 6 weeks. The nature of treatment for each foot lesion was concealed from the clinician. Before, and every 2 weeks during the study, erythema, lichenification, oozing and excoriations each were graded on a 10-point scale (maximal total score: 40). The primary outcome measures consisted of the percentage reduction from baseline of lesional scores, and the number of subjects whose scores had decreased by 50% or greater by the end of the study. Intent-to-treat analyses were used. At the beginning of the study, lesional scores were not significantly different between treatment groups. After 6 weeks, the percentage reduction from baseline scores was higher for tacrolimus-treated sites [median: 63% (95% CI: 39–67)] than for placebo-treated feet [3% (-2-13)] (paired t -test; P  < 0.0001). When tacrolimus was applied, lesions decreased by 50% or greater in 15 dogs (75%), while this benchmark was not reached for any placebo-treated feet (Fisher's exact test; P  < 0.0001). Adverse drug events consisted of minor irritation in some dogs treated with tacrolimus. Results of this randomized, controlled trial suggest that the daily application of 0.1% tacrolimus ointment is useful for reducing the severity of localized skin lesions of canine AD.
Funding: Self-funded.     

Use of sterile maggots to treat panniculitis in an aged donkey.

An aged female donkey developed a severe, localised, suppurative panniculitis secondary to a skin wound. Bacterial culture of swabs taken from the wound gave a profuse growth of multi-drug-resistant Pseudomonas aeruginosa, a profuse growth of Escherichia coli and a moderate growth of beta-haemolytic Streptococcus species. The lesion did not respond to conventional medical and surgical treatment and continued to progress. Six applications of sterile larvae (maggots) of the common greenbottle, Lucilia sericata, were used to debride the wound successfully.