Treatment of severe adverse cutaneous drug reactions with human intravenous immunoglobulin in two dogs

Severe adverse cutaneous reactions were documented in two dogs with acute skin lesions and systemic signs after exposure to several oral and injectable drugs. Because of the high morbidity and mortality rates of many severe cutaneous drug reactions and a poor response to supportive care, wound management, and conventional immunosuppressive therapy, human intravenous immunoglobulin (IVIG) was infused on 2 consecutive days (1 g/kg per day) after informed consent was received. Human IVIG, with supportive care, resulted in rapid resolution of dermatological and systemic signs in both dogs; this treatment may be considered in other cases of severe cutaneous drug reactions.     

Multiple myeloma in cats: variable presentation with different immunoglobulin isotypes in two cats

Multiple myeloma was diagnosed in two cats with monoclonal hyperglobulinemia, proteinuria, and plasma cell proliferations in bone marrow. An immunoglobulin G-producing myeloma occurred in the vertebral bone marrow of one cat, and twice responded to surgical reduction followed by a combination of local irradiation and chemotherapy. The cat's survival time was approximately 2 years. The other myeloma in a cat that presented with hypercalcemia and renal insufficiency involved visceral organs and produced a biclonal peak due to immunoglobulin A dimer formation on serum electrophoresis. This cat's tumor did not respond to chemotherapy.     

Successful intravenous human immunoglobulin treatment of drug-induced Stevens-Johnson syndrome in a dog

A two-year-old, male English springer spaniel developed severe mucocutaneous ulceration following treatment with trimethoprim-potentiated sulphadiazine. The clinical signs were consistent with Stevens-Johnson syndrome (SJS): there were no target or arciform lesions typical of erythema multiforme minor and major; more than one mucosal surface was affected; epidermal detachment affected less than 10 per cent of the body surface area; and there was a clear history of drug exposure. Systemic signs included a severe hepatopathy, dyspnoea, pyrexia and cachexia. Glucocorticoid therapy was associated with secondary infection by Pseudomonas aeruginosa. The clinical signs rapidly resolved following a single intravenous infusion of 0.51 g/kg human immunoglobulin (ivHIG) as a 5 per cent solution. By blocking FAS/FAS ligand (CD95/CD95L) interactions, ivHIG is thought to prevent keratinocyte apoptosis. It also binds to immunoglobulin G Fc receptors, inhibiting cell activation and cytokine synthesis, neutralises autoantibodies and immune complexes, blocks complement activity, is antimicrobial and increases colloid osmotic pressure. To the authors' knowledge, this is the first report of successful treatment of canine SJS using ivHIG, although it has been used to treat erythema multiforme in a cat and toxic epidermal necrolysis in a dog.     

Use of lomustine to treat cutaneous nonepitheliotropic lymphoma in a cat

A 17-year-old spayed female domestic shorthair cat was referred for evaluation of severe skin lesions, including ulceration, nodule formation, erythema, and alopecia. Cutaneous nonepitheliotropic lymphoma was diagnosed histologically. There was no evidence of visceral organ involvement, but renal function was decreased. The cat was treated with lomustine (45.5 mg/m2, PO, q 21 d), and skin lesions resolved after administration of the third dose. No severe toxicoses were identified. Results suggest that lomustine may be useful for treatment of cutaneous nonepitheliotropic lymphoma in cats; however, optimal dosage, efficacy, and potential adverse effects must be determined.     

Primary mycoplasma pneumonia associated with reversible respiratory failure in a cat

A young adult cat was evaluated for respiratory failure. Diagnostic testing, including computed tomography and culture, documented a primary Mycoplasma species pneumonia. The cat was treated aggressively with supportive care, including mechanical ventilation and appropriate antibiotics including doxycycline, and made a complete recovery. This is a unique case in respect of the severity of the Mycoplasma species pneumonia as well as the cat's recovery from severe lung injury.     

Poxvirus infection in a cat with presumptive human transmission

The present report describes a case of generalized cowpox virus infection with necrotizing facial dermatitis in a cat and a likely transmission to an animal keeper. The viral aetiology was confirmed by histopathology, immunohistochemistry, PCR, virus isolation, DNA sequencing and electron microscopy. Histopathological examination of the cat's skin revealed a severe, necrotizing dermatitis with ballooning degeneration and hyperplasia of epithelial cells with pathognomonic cytoplasmic eosinophilic inclusion bodies. Additionally, at post-mortem examination, a systemic poxvirus infection was detected affecting pancreas, thymus, lymph node, liver and lung. The human patient's skin biopsy revealed an ulcerative dermatitis with epidermal hyperplasia and ballooning degeneration. Serological investigation displayed a high orthopoxvirus-specific antibody titre in the human patient. Environmental factors increase the natural reservoir host population for cowpox viruses, such as voles, which results in a higher risk of infection for cats and subsequently for humans. Due to this zoonotic potential, a cowpox virus infection must be considered as an aetiological differential in cases of necrotizing dermatitis in cats.     

Erosive polyarthritis associated with Mycoplasma gateae in a cat

Erosive polyarthritis was diagnosed in an 11-month-old neutered male Egyptian Mau-cross cat with concurrent glucocorticoid-responsive dermatitis. Clinical signs, synovial fluid analysis, serological tests and radiographic appearance could not differentiate between immune-mediated and infective arthritis. Mycoplasma gateae was isolated by strictly anaerobic culture of the synovial fluid. Treatment with Enrofloxacin led to a rapid improvement of the cat's condition. Two months later the cat was euthanased because of severe glomerulonephritis and direct Coombs' test positive anaemia, possibly caused by mycoplasma infection. M gateae could not be isolated at post-mortem examination.     

Mycobacterial disease in cats in Great Britain: I. Culture results, geographical distribution and clinical presentation of 339 cases

This study investigated 339 cases of feline mycobacterial disease from cats with cutaneous lesions or masses found at exploratory laparotomy. Tissue samples were submitted to the Veterinary Laboratories Agency for mycobacterial culture over a 4-year period to December 2008. The study assessed which species of culturable mycobacteria were involved, where the cats lived, and their clinical presentation (physical findings, serum biochemistry, radiography, feline leukaemia virus and feline immunodeficiency virus status). Mycobacterium microti was cultured from 19%, Mycobacterium bovis 15%, Mycobacterium avium 7%, non-M avium non-tuberculous mycobacteria 6%, with no growth in 53% of samples. M microti, M bovis and M avium were found in almost mutually exclusive clusters within Great Britain (GB) (ie, M bovis in South-West England/Wales/Welsh Border, M avium in eastern England and M microti south of London and in South-West Scotland). While differences were seen in the clinical presentation and distribution of lesions caused by the different infections, these were not sufficiently different to be diagnostic. Cats commonly presented with single or multiple cutaneous lesions (74%), which were sometimes ulcerated or discharging, located most frequently on the head (54%). Lymph nodes were usually involved (47%); typically the submandibular nodes. Systemic or pulmonary signs were rarely seen (10-16%). When a cat is suspected of having mycobacteriosis, accurate identification of the species involved helps to determine appropriate action. Our findings show that knowing the cat's geographic location can be helpful, while the nature of the clinical presentation is less useful. Most cases of feline mycobacterial disease in GB are cutaneous.     

Laminectomy for treatment of cauda equina syndrome in a cat

A 16-year-old spayed female Siamese cat was presented with a history of paraparesis and obstipation. The cat's impaired function was attributed to malalignment of the L7-S1 spine (cauda equina syndrome) and to traumatic fracture of the left femoral neck, with severe degenerative arthritis. Laminectomy resolved the cauda equina problem, and the hip joint was not treated.     

Disseminated Mycobacterium avium-intracellulare Infection in a Persian cat

This report describes a disseminated infection with mycobacteria of the avium/intracellulare complex in a Persian cat in the absence of cutaneous lesions. Postmortem examination revealed severe granulomatous inflammation with numerous intrahistiocytic acid-fast bacilli in multiple organs. A gastrointestinal port of entry seems likely, as the ileocaecal lymph node was most severely affected.     

Disseminated Mycobacterium avium–intracellulare Infection in a Persian Cat

This report describes a disseminated infection with mycobacteria of the avium/intracellulare complex in a Persian cat in the absence of cutaneous lesions. Postmortem examination revealed severe granulomatous inflammation with numerous intrahistiocytic acid‐fast bacilli in multiple organs. A gastrointestinal port of entry seems likely, as the ileocaecal lymph node was most severely affected.     

Feline genetics: clinical applications and genetic testing

DNA testing for domestic cat diseases and appearance traits is a rapidly growing asset for veterinary medicine. Approximately 33 genes contain 50 mutations that cause feline health problems or alterations in the cat's appearance. A variety of commercial laboratories can now perform cat genetic diagnostics, allowing both the veterinary clinician and the private owner to obtain DNA test results. DNA is easily obtained from a cat via a buccal swab with a standard cotton bud or cytological brush, allowing DNA samples to be easily sent to any laboratory in the world. The DNA test results identify carriers of the traits, predict the incidence of traits from breeding programs, and influence medical prognoses and treatments. An overall goal of identifying these genetic mutations is the correction of the defect via gene therapies and designer drug therapies. Thus, genetic testing is an effective preventative medicine and a potential ultimate cure. However, genetic diagnostic tests may still be novel for many veterinary practitioners and their application in the clinical setting needs to have the same scrutiny as any other diagnostic procedure. This article will review the genetic tests for the domestic cat, potential sources of error for genetic testing, and the pros and cons of DNA results in veterinary medicine. Highlighted are genetic tests specific to the individual cat, which are a part of the cat's internal genome.     

Cutaneous nocardiosis in a cat

A 7-year-old cat was found to have multiple cutaneous lesions caused by Nocardia asteroides infection. The cat was treated successfully with potentiated sulfonamides and a combination of ampicillin and erythromycin.     

Erythema multiforme in dogs and cats: literature review and case material from the Cornell University College of Veterinary Medicine (1988–96)

A review of case material from the Cornell University College of Veterinary Medicine from 1988 to 1996 identified 20 dogs and one cat with definitive or presumed erythema multiforme. An additional 24 dogs and five cats with definitive or presumed erythema multiforme were found in the veterinary literature. Erythema multiforme accounted for only 0.40% and 0.11%, respectively, of all the canine and feline dermatology cases examined over a 9-year period. German Shepherd dogs and Pembroke Welsh Corgis appeared predisposed. The condition was manifested as a vesiculobullous and/or ulcerative dermatosis in the majority of dogs and cats. In dogs, the most commonly affected body sites included the ventrum (especially axillae and groin), mucocutaneous junctions, oral cavity, pinnae, and footpads. Histopathological findings in cutaneous and mucocutaneous biopsy specimens were consistent with previously published criteria. In dogs, erythema multiforme occurred more frequently in patients receiving drug therapy. In cats, all cases of erythema multiforme were presumed to be drug related. Elimination of the associated trigger factor and supportive care usually resulted in resolution of the erythema multiforme within 1–2 weeks. Four dogs with severe idiopathic erythema multiforme were successfully managed with glucocorticoids or azathioprine.     

Cutaneous metastases of a mammary carcinoma in a llama

An 8-year-old, female llama was evaluated for nonhealing, ulcerative, cutaneous lesions, which also involved the mammary gland. Biopsies of the lesions distant from and within the mammary gland area revealed an aggressive carcinoma. The tumor was confirmed at necropsy to be a mammary gland adenocarcinoma with cutaneous metastasis.     

Acute necrotizing dermatitis and septicemia after application of a d-limonene-based insecticidal shampoo in a cat

A 2-year-old female spayed domestic shorthair cat was examined because of lethargy, inappetance, vocalization, and abnormal aggressive behavior of 1 day's duration. The cat had been groomed the previous day with a d-limonene-based insecticidal shampoo. Skin lesions consisted of coalescing erythematous patches. Despite supportive care, the cat's condition deteriorated. Dermatohistopathologic changes included multifocal areas of acute coagulative epidermal necrosis. The dermis was infiltrated by a dense population of bacilli. d-Limonene toxicosis has been rarely described in dogs and cats. Toxic effects such as hypersalivation, ataxia, shivering, hypothermia, scrotal irritation, hypotension, and erythema multiforme major have been reported. Treatment for septicemia and disseminated intravascular coagulation, along with intensive supportive care, may be necessary.     

Congenital oligodontia of the deciduous teeth and anodontia of the permanent teeth in a cat

This report describes a rare case of congenital oligodontia of the deciduous teeth and anodontia of the permanent teeth in a cat. According to cat's veterinarian, the patient had only two deciduous upper canines and no permanent teeth had ever erupted. Post-mortem evaluation showed a complete absence of teeth in the oral cavity and inflammatory lesions were not found on the gums. Histopathological analysis of serial sections of maxilla and mandible revealed absence of odontogenic epithelium, inflammatory cells and odontoclastic resorptive lesions. Diagnosis was confirmed after both the establishment that there were no remaining dental structures and the exclusion of other relevant diseases that lead to tooth loss, such as periodontal disease, renal fibrous osteodystrophy, odontoclastic resorptive lesions, ectodermal dysplasia and trauma.     

Adult-onset cerebellar cortical abiotrophy and retinal degeneration in a domestic shorthair cat.

A 4-year-old, neutered male domestic shorthair cat presented for evaluation of ataxia and visual deficits. Neurological examination revealed severe cerebellar ataxia with symmetrical hypermetria and spasticity, a coarse whole-body tremor, positional vertical nystagmus, and frequent loss of balance. A menace response was absent bilaterally, and the pupils were widely dilated in room light. A funduscopic examination revealed markedly attenuated to absent retinal vessels and pronounced tapetal hyperreflectivity, findings consistent with end-stage retinal degeneration. Blood work evaluation included retroviral testing, a complete blood count, serum biochemistry analysis, taurine levels, and toxoplasma immunoglobulin G and immunoglobulin M titers. All were within reference ranges. The patient was euthanized, and a necropsy was performed. Microscopically, lesions of the nervous system were confined to the cerebellum and were consistent with cerebellar cortical abiotrophy. Selective photoreceptor degeneration was seen on histopathological examination of the retina with a reduction in the number of rods and cones. The combination of clinical findings and histopathological lesions seen here has not been previously reported in the cat.     

Topical tacrolimus (FK506) for the treatment of feline idiopathic facial dermatitis

A 3-year-old, neutered male Persian cat with chronic ulcerative facial dermatitis was diagnosed with feline idiopathic facial dermatitis based on signalment, clinical history and diagnostic test results, including dermatohistopathological evaluation. Initial treatment started with 4 weeks of oral antifungal/antibiotic medication for severe secondary infectious dermatitis of Malassezia and bacteria. As the lesions gradually improved, the oral medication was withdrawn, leaving only 0.1% topical FK506 (tacrolimus) ointment for the remaining lesions. Topical treatment was administered just in case any new lesions developed. The patient has been managed effectively with topical tacrolimus and no side-effects were observed during treatment. Feline idiopathic facial dermatitis is known as a difficult dermatosis to manage successfully, but our experience suggests that it may respond to topical tacrolimus.