P-52 A case of juvenile cellulitis concurrent with hindlimb paresis in an English cocker spaniel puppy

Pemphigus vegetans is a very rare cutaneous autoimmune blistering acantholytic disease of humans that combines features of both pemphigus foliaceus and mucosal lesions of pemphigus vulgaris. We report here the clinical, histopathological and immunological findings in a dog whose lesions resembled those of pemphigus vegetans of humans. A 4-year old, greater Swiss mountain dog was presented with verrucous papules and crusts on the axillae and inguinal region. Within 3 months, lesions progressed to involve the thorax and ear pinnae, and then became generalized. Ulcers were observed in the oral cavity, anus and prepuce. Microscopic examination of mucosal and cutaneous biopsy specimens revealed a mixed pattern of deep intraepidermal neutrophilic and eosinophilic pustules with isolated and clustered acantholytic keratinocytes, along with suprabasal epidermal clefts leaving rounded basal keratinocytes at the bottom of the vesicles. These dual changes were also observed within the hair follicle epithelium. Dermal inflammation was mixed and perivascular. Direct immunofluorescence revealed IgG deposited around epidermal keratinocytes. Indirect immunofluorescence performed on normal canine gingival substrate uncovered antikeratinocyte IgG autoantibodies with a serum titre of 1:2500. Immunoblotting confirmed that circulating IgG autoantibodies recognized the extracellular segment of canine desmoglein-1 and human desmoglein-3. Treatment with azathioprine and oral glucocorticoids resulted in long-lasting complete remission. In this dog, clinical signs, microscopic skin lesions and immunological findings were deemed analogous to those of human Neumann-type pemphigus vegetans.
Funding: Self-funded.