Thromboembolism in a bitch - diagnosis by infrared thermography

Background: Thermography is a noninvasive, non-contact, painless, and non-ionizing imaging technique that records cutaneous thermal patterns generated by infrared emission of the surface. The surface heat is closely related to dermal microcirculation. Thromboembolism is responsible for important changes in the thermal pattern of the body surface due to physical obstruction of blood flow, being the main complication in immune-mediated hemolytic anemia. The aim of this paper is to report a dog with thrombus in his left forelimb secondary to idiopathic hemolytic anemia, whose diagnostic screening was performed through infrared thermography. Case: A 9-year-old mixed breed bitch was referred to a veterinary hospital with a history of emesis, diarrhea and dark-colored urine for 2 days. The complete blood count showed hypochromic macrocytic anemia (hematocrit [HTC] 28%, reference: 37 to 55%) with the presence of nucleated erythrocyte (14/100 leukocytes, reference: 0 to 5/100 leukocytes), polychromasia and spherocytes. Leukocytosis (28,300 mm³, reference: 6,000 to 17,000 mm³) by neutrophilia with left deviation and toxic granulations was also present, in addition to hemoglobinuria at urine exam. Therefore, treatment for immune-mediated hemolytic anemia (IMHA) was instituted. After 2 days, the animal returned with acute functional impairment of the left forelimb. Physical examination revealed that the limb was cold, without pulse, proprioception, reflexes, and deep pain. New blood analyses revealed decreased hematocrit (HTC 17%, reference: 37 to 55%), and increased total leukocyte number (57,000 mm3, reference: 6,000 to 17,000 mm³). Infrared thermography revealed an important temperature difference between the limbs, with the affected limb temperature considerably lower (31.3ºC) when compared to the contralateral limb (35.0ºC). Thermography showed the site of the thrombus in the medial portion of the limb (cephalic vein), where the catheter had been placed for fluid therapy. Due to the severity of the condition, the bitch was submitted to amputation surgery, which occurred without complications. The patient had a good response to treatment, with decreased signs of hemolysis and hypercoagulability. The medications were slowly withdrawn, and the clinical discharge occurred after 4 weeks. Discussion: In humans, thermography has been widely used in the assessment of thrombotic diseases, contributing to diagnosis, localization, and prognosis. In veterinary medicine, however, the use of this tool in the diagnosis of thromboembolism is still rare. The difference of 3.7°C between the affected and contralateral limb was objectively verified using thermography. A minimum difference of 2.4°C between limbs has high sensitivity and specificity for diagnosing thromboembolism and occurs due to the reduction in local blood flow. In the present case this tool was essential for the anatomical location of the thrombus, which was in the middle third of the forearm, and allowed an adequate surgical planning. It is known that the main complication of IMHA is thromboembolism. Its predisposing factors include venous stasis, endothelial damage, and hypercoagulability, being exacerbated by cage confinement, decubitus and presence of a peripheral venous catheter. The reported case corroborates at least one of these factors since it had a peripheral venous catheter in the left forelimb, which later showed absence of pulse, spinal reflexes, pain and proprioception. The thermography showed to be an objective, rapid and non-invasive tool to diagnose and precisely locate the thrombus, which allowed for adequate treatment and surgical planning for the case. To the best of our knowledge, this is the first report about use of thermography to diagnose thromboembolism secondary to immune-mediated hemolytic anemia in a dog.

Poliartrite em cão por Leishmaniose - tratamento com miltefosina / Polyarthritis in a dog due to leishmaniasis - treatment with miltefosine

Background: Canine visceral leishmaniasis causes several clinical signs, such as lymphadenomegaly, exfoliative dermatitis, ulcerative skin lesions, and lameness. The most commonly reported locomotor changes are claudication, edema, arthralgia, joint stiffness, and muscle atrophy. Radiographic exam revealed cortical and medullary destruction, increase, or decrease in medullary opacity, proliferative periosteal reaction, osteolysis, collapse of joint spaces and soft tissue edema are observed. The aim of this report is to describe the clinical and radiographic evolution of a case of erosive polyarthritis associated with leishmaniasis in a dog before, during and after treatment with miltefosine. Case: A 7-month-old mixed-breed dog was attended due pain and limited mobility. In the orthopedic evaluation, joint swelling, stiffness, and increased pain sensitivity of the four limbs, as well as neck stiffness, were noted. Radiographic examination showed joint changes compatible with edema, with increased volume and radiopacity of the soft tissues adjacent to the joints. The segments of the patient's spine showed more severe bone alterations, the cervical spine being one of the most affected regions, with multiple bone proliferations throughout the vertebral body, especially in the ventral portion (spondylosis), compatible with polyarthritis due to leishmaniasis. Due to the suspicion, lymph node and spleen cytology was performed, confirming the diagnosis. Hematological examination revealed anemia, leukopenia due to lymphopenia and thrombocytopenia in addition to increased AST (79,4 U/L; reference: 6,2 - 13 U/L), creatine kinase (517,6 U/L; reference: 1,5 - 28,4 U/L), lactate dehydrogenase (688,4 IU/L; reference: 45 - 233 IU/L) and hyperproteinemia (7,34 g/dL; reference: 5,4 - 7,1 g/dL). Treatment with miltefosine, allopurinol, domperidone, prednisone, gabapentin and dipyrone was started. Reassessments were performed monthly for 3 consecutive months. Hematological examinations showed improvement, with resolution of anemia and thrombocytopenia, and a marked decrease in creatine kinase values. Thus, it is evident that the dog did not develop liver or kidney changes during treatment. During the treatment and monitoring in this period, the dog had a clinical improvement, which started to walk without pain. In addition, joint swellings were no longer present, however, there was no improvement in the radiographic evaluation of the joints. Discussion: Clinical signs of the locomotor system are compatible with those described in animals that had osteoarticular manifestations associated with leishmaniasis, such as arthralgia, edema, and joint stiffness. In the present report, treatment with miltefosine associated with allopurinol resulted in an improvement in the clinical picture, and this therapy is therefore promising in dogs with polyarthritis due to leishmaniasis. A case published in human medicine demonstrated the intra-articular absorption capacity of this drug. There is only one study to date that describes the radiographic evolution of a dog with arthritis due to leishmaniasis after treatment with miltefosine and allopurinol. In this case described, the dog reported remained with the osteoarticular lesions after treatment, although clinical improvement was observed, as in our report. The use of miltefosine and allopurinol are in accordance with stage II staging for leishmaniasis. In this study, although there was no improvement in the radiographic examinations, the treatment was effective in the remission of the animal's clinical condition.

Anti-Toxoplasma gondii and anti-Neospora caninum antibodies in dogs with and without neurological signs / Anticorpos anti-Toxoplasma gondii e anti-Neospora caninum em cães com e sem sinais neurológicos

This study investigated the association between neurological signs as well as plausible risk factors and the seroprevalence of Toxoplasma gondii and Neospora caninum infection in dogs of the Campo Grande region of Mato Grosso do Sul, Brazil. In this study, the dogs were divided into two groups based on the presence and the absence of neurological signs (n=30 in each group). Serological diagnosis was performed using the indirect fluorescent antibody test. In the group with neurological disorders, 23.3% and 30% of the dogs had anti-T. gondii and anti-N. caninum antibodies, respectively. Moreover, three dogs from this group showed co-infection with both protozoa. In the group without neurological signs, 16.7% and 13.3% of the dogs were seropositive for T. gondii and N. caninum, respectively. Although presence of neurological signs was not associated with T. gondii and N. caninum infections (P = 0.747 and P = 0.21, respectively), there was a statistical association between T. gondii seropositivity and peripheral neurological alteration (P = 0.016) among dogs with neurological signs. Raw meat ingestion was the only risk factor associated with the presence of anti-N. caninum antibodies (P = 0.041). Results revealed evidence of exposure to N. caninum and T. gondii in dogs irrespective of the presence of neurological signs. Moreover, this study highlighted the need for serological investigation of T. gondii in dogs with disturbances in peripheral nervous systems and not offering raw meat to animals to avoid the risk of N. caninum infection.

Este estudo teve como objetivo investigar a associação entre sinais neurológicos, assim como possíveis fatores de risco e soroprevalência de Toxoplasma gondii e Neospora caninum em cães de Campo Grande, região de Mato Grosso do Sul, Brasil. Nesse estudo, os cães foram divididos em dois grupos, baseado na presença ou ausência de sinais neurológicos (n = 30 em cada grupo). O diagnóstico sorológico foi realizado por meio do teste imunofluorescência indireta (RIFI). No grupo com distúrbios neurológicos, 23.3% e 30% dos cães tinham anticorpos anti-T. gondii e anti-N. caninum, respectivamente. Além disso, três cães deste grupo estavam coinfectados com ambos os protozoários. No grupo sem sinais neurológicos, 16.7% e 13.3% dos cães foram soropositivos para T. gondii e N. caninum, respectivamente. Apesar da presença de sinais neurológicos não ter sido associado a infecção por T. gondii ou N. caninum ( P = 0.747 e P = 0.21, respectivamente), houve associação estatística entre soropositividade para T. gondii e alteração neurológica periférica (P = 0.016) entre os cães com sinais neurológicos. A ingestão de carne crua foi o único fator de risco que apresentou associação com a presença de anticorpos para N. caninum (P = 0.041). Estes resultados mostraram evidência de que a exposição a N. caninum e T. gondii em cães independe da presença de sinais neurológicos. Além disso, este estudo destaca a necessidade de investigação sorológica para T. gondii em cães com distúrbios neurológicos periféricos, e o oferecimento de carne crua aos animais deve ser evitada devido ao risco de infecção por neosporose.

Pneumocephalus and suppurative meningoencephalitis in a dog after craniofacial trauma

Background: Pneumocephalus is characterized by the presence of gas in the intracranial compartment, and it can be developed by trauma, craniofacial surgery or spontaneously. Clinical signs start within days or months after the injury and vary according to the site of involvement. Computed tomography is the ideal diagnostic tool, however skull radiography can also be used. Treatment varies according to the severity of the case, and it can be conservative or associated with surgical intervention in the most severe cases. The purpose of this report is to describe the case of a dog that developed pneumocephalus and suppurative meningoencephalitis after head trauma caused by a bite from another dog. Case: A 2-month-old bitch, mixed breed, with 3.2 kg, was referred to the Veterinary Hospital because it had been bitten on the head by another dog. Shortly after the incident, the animal showed no clinical signs. However, 2 days later, the bitch became depressed and in persistent lateral decubitus. A lesion with a crust of approximately 0.5 cm was found close to the occipital region, with bone irregularity on palpation. The animal was in lateral decubitus with muscular hypotonia, bilateral mydriasis unresponsive to light and stupor. Radiographic images showed parietal fracture and pneumocephalus. Based on the findings of physical and laboratorial exams, diagnosis of suppurative meningoencephalitis and pneumocephalus secondary to craniofacial trauma was established. Empirical broad-spectrum antimicrobial therapy was started in addition to mannitol, corticoids, and analgesics. The animal was referred for surgical debridement by trepanation, when samples were collected to bacterial culture, which was negative. Despites the care, the animal died 14 h after the surgical procedure. Histopathological examination of the frontal cortex was performed, being the histological changes compatible with suppurative meningoencephalitis. Discussion: Dog bites on the head and neck are particularly severe, and can create intracranial bleeding, disfigurement of the face, damage to peripheral structures or cranial fractures. In this report, through radiographic images, it was found that the patient had an intracerebral aerocele, since there was presence of gas in the intracranial compartment. This alteration should always be considered in animals with neurological alterations and a history of craniofacial trauma. The main neurological changes observed in the reported case were unresponsive to mydriasis and altered mental status 2 days after the trauma, and this delay in the onset of clinical signs is frequently reported in cases of pneumocephalus. Neutrophilia and leukocytosis observed can be justified by the suppurative meningoencephalitis, confirmed by the histopathological exam. Antimicrobial therapy should be started as soon as possible, and the choice must be based on their capacity to cross the blood-brain barrier and the broad spectrum. The administration of antibiotics before collecting the material for bacterial culture may explain the negative result of this test, so that it is not possible to determine whether the intracranial gas observed on the radiograph may have developed from the trauma or because of gas-producing bacteria. Head trauma can induce suppurative meningoencephalitis and pneumocephalus even in the absence of perforating wounds at the time of the consultation. The neurological signs can start days after the trauma. Besides the clinical and surgical treatments, the prognosis of any bacterial infection of the central nervous system is poor.

Polymyositis associated with brainstem signs in a dog

Background: Polymyositis is a generalized inflammatory myopathy which can lead to rhabdomyolysis. This affection may have several origins, including degenerative, metabolic, autoimmune, infectious, inflammatory, ischemic, traumatic, by drug use, induced by toxins and also of idiopathic origin. Diagnosis is made with seric dosage, electrodiagnostic tests and muscle biopsy. Lesions in the rostral oblong medulla may affect the central vestibular system, and there may be signs such as opisthotonos, nystagmus, and strabismus. The aim of this report is to describe a case of a mixed breed dog with manifestation of polymyositis associated with brainstem signs of probable idiopathic origin. Case: A 5-year-old mixed breed male dog was attended with opisthotonos episodes for 2 days, and pelvic limbs extension and thoracic limbs flexion that lasted 10 to 20 min at intervals of approximately 1 h. The animal was anorexic and had also presented one episode of emesis. Upon neurological examination, ventromedial strabismus and Horner's syndrome was observed on the right side, besides vertical nystagmus, flaccid tetraparesis and absence of proprioception in the four limbs. Biochemical analyses revealed creatine kinase (CK) increased (2,433.9 UI/L - reference: 1.5-28.4 UI/L), and urinalysis showed dark color and presence of occult blood without, however, erythrocyturia. Electrocardiogram (ECG) showed QS wave and deviation of the electrical axis. Treatment with prednisolone (1 mg/kg, BID), phenobarbital (2 mg/kg, BID), maropitant citrate (1 mg/kg in 2 doses), and crystalloid fluid therapy (50 mL/kg/day) were prescribed. On the 4th day, the dog was more active and feeding without a tube, so it recommended keep the treatment at home. On the 10th day, the animal had proprioception present on the 4 limbs and normorexia. Biochemical analyses and urinalysis showed no alterations, but normochromic normochromic anemia with thrombocytopenia and leukocytosis by neutrophilia showed in blood count exam. PCR to Ehrlichia canis, Hepatozoon sp., and Babesia canis resulted negative. On the 15th day, blood count, biochemical analyses and urinalysis showed no alterations. Neurological examination revealed only positional vertical nystagmus. which remained as a sequel. Discussion: Polymyositis may be accompanied by rhabdomyolysis, characterized by acute muscle necrosis, increased CK and myoglobinuria. The animal had polymyositis of acute onset, with myoglobinuria and elevated CK values, whose presentation included myalgia and muscle weakness. In humans, polymyositis is accompanied by changes in electrocardiographic tracing without clinical alterations. In dogs, the first report that showed cardiac involvement was compatible with myocarditis. The changes in ECG in the present case was attributed to failure in myocardial electrical conduction. The patient also showed signs of brainstem and central vestibular system injuries. Stress myopathy, intoxication, snakebite, infectious, and metabolic diseases were discarded leading to a clinical suspicion as idiopathic origin. Similar to a published case, the patient of this report received symptomatic and supportive treatment, being discharged from the hospital 20 days after the onset of clinical signs. Thus, polymyositis may be accompanied by signs indicative of brainstem injury. Patients with rhabdomyolysis require intense monitoring due to the high risk of developing acute renal failure. Since no causative agent was identified, symptomatic treatment combined with the prevention of possible complications were fundamental for the maintenance of the animal's life.

Feline aortic thromboembolism diagnosed by thermography

Background: In cats, arterial thromboembolism is one of the most devastating diseases, with an acute presentation, andis often caused by undiagnosed cardiomyopathy. Defined as the obstruction of one or more arterial lumens by emboli,the arterial thromboembolism is responsible for hypoperfusion signs. As the temperature of the skin surface is directlyrelated to tissue perfusion, thermography can be promising for the early diagnosis of thromboembolism. Therefore, thisstudy reports the importance of thermography as a complementary examination for the diagnosis of thromboembolism inthe abdominal aorta of a domestic cat.Case: A 4-year-old mixed-breed cat weighing 2.95 kg was presented with a history of sudden onset paraplegia, apathy,and pain when handled, with greater intensity in the sacro-coccidian region. During physical exam, it was noted that thefemoral artery pulse was undetectable bilaterally during manual pulse measurement. Superficial and deep sensitivity inthe pelvic limbs and proprioception were also absent and the plantar cushions and nail beds of the posterior limbs werepale to cyanotic. Thermographic images revealed that the temperature of both hind limbs was lower than that of forelimbs,with difference of 3.2ºC and 2.9ºC between the left and right limbs, respectively. Doppler ultrasonography revealed theabsence of pulse and flow in the femoral arteries bilaterally. Electrocardiography revealed sinus tachycardia, with a heartrate of 250 bpm. Echocardiography revealed dilation of the left atrium and concentric cardiac hypertrophy. After 24 h, dueto the worsening of the clinical condition and unfavorable prognosis, the animal was euthanized and sent for necropsy.Necropsy revealed that the arterial lumen of the caudal abdominal aorta and bifurcation of the iliac arteries were obliterated...

Feline aortic thromboembolism diagnosed by thermography

Background: In cats, arterial thromboembolism is one of the most devastating diseases, with an acute presentation, andis often caused by undiagnosed cardiomyopathy. Defined as the obstruction of one or more arterial lumens by emboli,the arterial thromboembolism is responsible for hypoperfusion signs. As the temperature of the skin surface is directlyrelated to tissue perfusion, thermography can be promising for the early diagnosis of thromboembolism. Therefore, thisstudy reports the importance of thermography as a complementary examination for the diagnosis of thromboembolism inthe abdominal aorta of a domestic cat.Case: A 4-year-old mixed-breed cat weighing 2.95 kg was presented with a history of sudden onset paraplegia, apathy,and pain when handled, with greater intensity in the sacro-coccidian region. During physical exam, it was noted that thefemoral artery pulse was undetectable bilaterally during manual pulse measurement. Superficial and deep sensitivity inthe pelvic limbs and proprioception were also absent and the plantar cushions and nail beds of the posterior limbs werepale to cyanotic. Thermographic images revealed that the temperature of both hind limbs was lower than that of forelimbs,with difference of 3.2ºC and 2.9ºC between the left and right limbs, respectively. Doppler ultrasonography revealed theabsence of pulse and flow in the femoral arteries bilaterally. Electrocardiography revealed sinus tachycardia, with a heartrate of 250 bpm. Echocardiography revealed dilation of the left atrium and concentric cardiac hypertrophy. After 24 h, dueto the worsening of the clinical condition and unfavorable prognosis, the animal was euthanized and sent for necropsy.Necropsy revealed that the arterial lumen of the caudal abdominal aorta and bifurcation of the iliac arteries were obliterated...(AU)

Primary adipsia and severe hypernatremia in a Pit Bull dog / Adipsia primária e hipernatremia severa em um cão Pit Bull

Primary adipsia is a rare condition in which there is failure in the activation threshold of the hypothalamic osmoreceptors, leading to osmolality imbalance. Here, we reported the case of a Pit Bull dog with an altered level of consciousness (started after weaning) and adipsia. There was an increase in plasma osmolality (444 mOsm/kg), sodium (223.7 mg/dL), and chlorine (173 mg/dL) levels. Based on the suspicion of primary adipsia, water was administered via a nasogastric tube, with clinical improvement. The owner was instructed to supply water with food. Eight months after discharge, the dog returned with parvovirus and died. In the anatomopathological examination, no structural changes were observed in the central nervous system. To our knowledge, this is the first report of hypernatremia due to adipsia in a Pit Bull dog, showing that this is a differential diagnosis that should be considered in this breed.

Adipsia primária é uma rara condição em que há falha no limiar de ativação dos osmoreceptores hipotalâmicos, levando ao desequilíbrio da osmolalidade. Este artigo tem como objetivo relatar o caso de um cão da raça Pit Bull apresentando alteração no nível de consciência (iniciado após o desmame) e adipsia. Foi verificado aumento da osmolalidade plasmática (444 mOsm/kg), sódio (223,7 mg/dL) e cloro (173 mg/dL). Baseado na suspeita de adipsia primária, iniciou-se administração de água via sonda nasogástrica, com melhora clínica. O tutor foi orientado a fornecer água junto a alimentação. Oito meses após alta, o paciente retornou com parvovirose e veio a óbito. No exame anatomopatológico, não foram observadas alterações estruturais no sistema nervoso central. Este é o primeiro relato de hipernatremia por adipsia em um cão Pit Bull, mostrando que este é um diagnóstico diferencial que deve ser considerado nesta raça.

Chemodectoma in a bitch

Background: Chemodectomas, better known as tumors of the base of the heart, arise from aortic bodies, respiratory chemoreceptors located near or inside the aortic arch or originate from receptors located in the carotid arteries. Relatively rare, they affect dogs and, to a lesser extent, cats. They gain great importance when they influence the function of the cardiovascular system, with animals showing clinical signs related to congestive heart failure. Clinical diagnosis is based on symptomatology and complementary tests such as radiography, electrocardiography and echocardiography, while the definitive diagnosis is obtained by cytological and histopathological exams. This study aims to reports a case of malignant chemodectoma in a bitch, whose main symptomatology was neurological and not cardiovascular. Case: A 1-year-old Rottweiler bitch was attended with neurological alterations compatible with vestibular syndrome, hyporexia, dysphagia, apathy, melena, emesis, and purulent nasal discharge on the right nostril. On physical examination, the animal showed depressed level of consciousness, poor body condition, bilateral quemosis, paralysis of the right eye, inspiratory dyspnea and muffling of cardiac auscultation, besides a subcutaneous nodule between the scapulae. On neurological evaluation, horizontal nystagmus, head tilt to the right side, ventromedial strabismus and facial nerve paralysis on the right side were observed so that the localization of the lesion was set in peripheral vestibular system. During anesthesia for esophageal tube placement, a mass from the hard palate to the oropharynx was noted, making endotracheal intubation impossible to perform. Biopsy of this nodule was performed, and tracheostomy was indicated, but the owner opted for euthanasia before the procedure. Necropsy revealed white soft masses in the bilateral retromandibular region, on the subcutaneous tissue near the scapulae, in the right ear and since nasopharynx to the soft palate, in addition to sparse white nodules in the heart, lung, carotid artery, kidneys, right ovary, mesentery near to the spleen, and axillary lymph node. Histologically, the nodules were characterized by neoplastic cells population organized in short bundles or cords, arranged around small blood vessels surrounded by delicate connective tissue. Neoplastic cells infiltrated muscles and blood and lymphatic vessels were filled by multiple neoplastic emboli. The histological pattern of the cells allowed the diagnosis of chemodectoma. Discussion: The bitch from this case had 1-year-old when diagnosed with chemodectoma, differently from most cases from literature, that are between 7 to 15 years old. Furthermore, primarily cardiac tumors are considered rare, being chemodectoma the most common, often reported in Boxer and Boston Terrier dogs, but unusual in Rottweilers. Despites some articles mentioning seizure and Horner's Syndrome secondary to a carotid body chemodectoma, neurological signs are not commonly observed in these cases. The presence of the tumor in the middle ear region of the right side supports the occurrence of peripheral vestibular syndrome and facial nerve paralysis on the same side. Because it is a neoplasm that is usually detected late during the course of the disorder, most patients either cannot obtain diagnosis in vivo, as in this reported animal, which was in such a critical condition that underwent euthanasia, or there are no more possible therapeutic choices. In the patient described, there were numerous metastatic masses and nodules spread throughout the body. Although the typical clinical signs in animals with chemodectomas are often related to heart disease, neurological signs may also be present. This report emphasizes the importance of chemodectoma being included as a differential diagnosis in young dogs and even in breeds such as Rottweiler.

Ehlers-Danlos syndrome in a crossbreed cat / Síndrome de Ehlers-Danlos em um gato mestiço

The Ehlers-Danlos syndrome (EDS) consists of a group of diseases characterized by defective collagen production or failure in its organization, resulting in changes in the strength and extensibility of connective tissue. This report describes the dermatological and histological findings observed in a 3-month-old crossbreed cat with rupture and detachment of skin in the thoracic limb and rupture of the skin in the cervical region. Upon dermatological examination, the cat presented fragile and hyperextensible skin in the cervical region and a skin extensibility index of 21%. Histopathological evaluation of the skin specimens revealed evident disorganization of collagen bundles in dermis and in the Masson's trichrome staining, follicular dysplasia was found. The presumptive diagnosis of EDS was made based on the clinical and histopathological findings. Sanger sequencing did not detect any mutated alleles for the c.3420delG mutation in COL5A1 gene, which was an autosomal dominant mutation previously been associated with Ehlers-Danlos syndrome in cats. The absence of this mutation in the reported cat suggests that other mutation may also be responsible for the development of cutaneous asthenia in this or maybe other genes related to collagen metabolism.

A síndrome de Ehlers-Danlos (EDS) consiste em um conjunto de doenças caracterizadas pela produção deficiente de colágeno ou falha em sua organização, resultando em alterações na resistência e extensibilidade do tecido conjuntivo. Este relato descreve os achados dermatológicos e histológicos observados em um gato mestiço de três meses de idade com ruptura e descolamento de pele do membro torácico e ruptura da pele na região cervical. Ao exame dermatológico, o gato apresentava pele hiper-extensível, fragilizada na região cervical e índice de extensibilidade cutânea de 21%. A avaliação histopatológica das amostras de pele revelou desorganização evidente dos feixes de colágeno na derme e pela coloração com tricrômico de Masson foi encontrada displasia folicular. O diagnóstico presuntivo de EDS foi realizado com base nos achados clínicos e histopatológicos. O sequenciamento de Sanger não detectou nenhum alelo mutado para a mutação c.3420delG no gene COL5A1, que é uma mutação autossômica dominante previamente associada à síndrome de Ehlers-Danlos em gatos. A ausência dessa mutação no gato relatado sugere que outra mutação também pode ser responsável pelo desenvolvimento de astenia cutânea neste gene ou em outro associado ao metabolismo de colágeno.

Acute erythroid leukemia in a cat infected with feline leukemia virus

Background: Erythroid leukemia is a myeloproliferative hematopoietic disorder considered acute when there is a predominance of blasts in the bone marrow. It is frequently reported in cats infected with feline leukemia virus, but it is unclear whether this virus is involved in the oncogenesis. The clinical signs in cats are anorexia, apathy, weight loss, with evolution from 2 weeks to 2 months, pale mucous membranes, hemorrhages, ascites, salivation, and dyspnea due to pleural effusion. This affection responds little to chemotherapy with an unfavorable prognosis. The aim of this study is to report a case of a feline leukemia virus infected cat with the onset of severe hemolytic anemia. Case: A 8-year-old male mixed breed cat was attended with a history of anorexia, oligodipsia, apathy, progressive weight loss, and yellowish color of urine for 7 days. Laboratorial exams showed anemia (with metarubricytes, acanthocytes and ghost cells), leukocytosis and FeLV reagent test. The cat underwent treatment with methylprednisolone acetate and supportive care. One day later, the animal returned with icteric mucous membranes, and emesis. A blood count was performed that found worsening anemia, increased leukocytosis, and lymphocytosis. Abdominal ultrasound showed cholangiohepatitis and lymphadenomegaly in mesenteric lymph nodes. Treatment was started with ondansetron, metronidazole, and amoxicilin with potassium clavulanate. The cat returned after 3 days and laboratorial exams revealed worsening of blood parameters, so blood transfusion was performed. After 2 days, the patient started with dyspnea and hypothermia, that evolved to cardiorespiratory arrest. The body was sent to necropsy and histopathology, where blast cells and rubricytes were found in blood vessels of various organs. The bone marrow was markedly cellular with complete disappearance of adipose tissue. Most of the cells were blasts with abundant and eosinophilic cytoplasm, central nucleus with finely dotted chromatin and a large nucleolus. There were rubricytes, which made possible to confirm acute erythroid leukemia as a morphological diagnosis. Discussion: The clinical signs observed in acute erythroid leukemia are lethargy, inappetence, fever, splenomegaly, mild lymphadenomegaly, associated with leukocytosis, severe anemia, and thrombocytopenia. The reported animal presented signs similar to those described in the literature except that there was no change in platelet counts. The diagnosis of leukemia was reached after histopathology, and it is made when is observed more than 30% of myeloblasts and monoblasts together or when the blast cells count including rubriblasts is greater than 30%. Although chemotherapy, the prognosis is usually poor. It is essential to perform the myelogram for the diagnosis of myeloid leukemias in vivo. In this report, we only achieve final diagnosis after the cat's death, due to the aggressive behavior of the disease. Clinicians must be aware of the likely development of acute erythroid leukemia whenever a feline leukemia virus infected cat presents hemolytic anemia to get an early diagnosis, since this is an extremely aggressive disease, to propose prompt chemotherapy and give the patient a longer survival period.

Estrutura óssea exógena traqueal em um gato / Exogenous tracheal bone structure in a cat

Background: Acute dyspnea is a clinical emergency with a presentation similar to several etiologies. Cats are usually referred with complaints of anorexia, abdominal breathing, cyanosis, and open mouth breathing, and veterinarians should stabilize the animals as soon as possible. The incidence of aspiration of foreign bodies is low, particularly in this species. The diagnosis consists of observing the foreign structure in the lumen of the trachea, commonly performed using radiography or bronchoscopy. This report describes a case of a feline with a tracheal foreign body, with a detailed description of the clinical findings and successful treatment. Case: A 10-year-old female feline exhibited severe dyspnea and cyanosis. During the anamnesis, the owner stated that the clinical signs suddenly presented one day prior, after the animal ingested a piece of fish. Physical examination revealed changes in pulmonary auscultation, which was bilaterally muffled, and intense respiratory distress, as observed by the evident signs of exhaustion (sternal decubitus, reduced muscle tone), in addition to cyanotic mucous membranes. The animal was intubated and maintained under anesthesia with propofol infusion and respiratory support (ambu) for 1 h, during which complementary examinations were performed. Chest radiography showed the presence of a radiopaque structure (approximately 0.5 cm) in the tracheal region. Thus, we decided to remove the structure using bronchoscopy. The foreign body was located above the main bronchial bifurcation and was removed. There was an improvement in oxygenation after 20 min of maintenance of ventilatory support, followed by weaning of the animal's successful respiratory support. Antibiotic therapy and analgesia were prescribed at home, and the animal exhibited full recovery after 10 days. Discussion: Dyspnea is a clinical sign that should be treated as an emergency, as it is associated with high mortality. In these cases, positive pressure ventilation is indicated in three situations: persistent hypoventilation, severe hypoxemia unresponsive to oxygen therapy, and excessive respiratory effort or fatigue. Dyspnea may be due to impairment of the upper or lower airway or restrictive conditions. Clinically, felines with tracheal foreign bodies have a sudden onset of dyspnea, tachypnea, cough, and lethargy. In these patients, the reduction in lung sounds is a common finding, as observed in the present case. The occurrence of tracheal foreign bodies in cats is rare and, depending on the type of foreign body and its location in the airway, complete obstruction of the respiratory tract may occur. In the present case, it was possible to observe the foreign body in the trachea on radiographic images. Felines with tracheal foreign bodies generally present a structure located close to the carina, as observed in the present case. Bronchoscopy using a flexible or rigid tube is considered the gold-standard technique for removing foreign bodies from the respiratory tract, and the greatest difficulty during the removal procedure is ensuring that the airways are not obstructed by the instruments used. The use of these materials is not free of complications, as they may be responsible for the development of pneumothorax, pneumomediastinum, dyspnea, and respiratory failure. In the present case, there were no complications during or after the procedure, and the patient recovered completely.(AU)

Liver cysts in a kitten with Platynosomum sp

Background: Hepatic cysts are rarely described in association with infections by Platynosomum sp. Infected animals are most often asymptomatic, and the severity of symptoms is associated with the number of biliary tract parasites, which may lead to cholangitis and cholangiohepatitis. Although platinosomiasis is often associated with cholangitis and cholangiohepatitis, it rarely is with polycystic disease. For the parasite's life cycle to occur, the infected cat must eliminate the eggs in the feces and three intermediate hosts are needed: snails, terrestrial isopods and vertebrates like the frog or the gecko. The eggs are ingested by the snails, then the miracids are released and matured into the mother sporocyst form, which originates child sporocysts containing the cercariae, that leave the mollusks for the soil and are ingested by the terrestrial isopod in which the cercariae matures until metacercariae. Vertebrates ingest terrestrial isopods and are ingested by felines. The present study aimed to report an unusual case of platinosomiasis with the development of multiple hepatic cysts. Case: A mixed breed male kitten was admitted with a history of apathy, hyporexia, increased abdominal volume and jaundice. In the ultrasound examination, we could see hepatomegaly and several hypoecogenic rounded structures, similar to cysts. There was an increase of serum concentration of the hepatic enzymes alanine transaminase and gamma glutamyl transferase enzyme. The parasite's eggs were investigated in the patient's feces using the simple sedimentation method, with a negative result. The animal was submitted to celiotomy and it was possible to observe several cystic structures in the liver. The cysts content was sent to cytology and culture. Cytology result was compatible with liver cyst and there was no bacterial growth in the culture. Bile fluid was collected and sent for Platynosomum sp. research using the centrifugal sedimentation test in formalin-ether solution, which allowed the parasite's eggs to be observed. The cat was treated with praziquantel,silymarin, S-Adenosyl methionine, and ursodeoxycholic acid. The patient gradually improved from jaundice and there was a reduction in abdominal volume. Discussion: This report describes a case of platinossomiasis associated with polycystic liver disease in a domestic cat, which seems to be an uncommon presentation. Most infected cats are asymptomatic, but some animals may exhibit anorexia, apathy, increased abdominal volume due to hepatomegaly and/or ascitis and jaundice. Although infestation in domestic cats is relatively common, its association with liver cysts is rare or poorly reported in the literature, representing a diagnostic challenge, which makes mandatory the inclusion of this differential diagnosis in polycystic liver diseases in cats. The diagnosis of this parasitosis can be made based on the association among clinical signs, laboratory tests and ultrasound examination, but the definitive diagnosis is usually made by visualizing the parasite's eggs. In the case described, it was not possible to observe parasite's eggs in the patient's feces, but in the bile. Platynosomum sp. infection should always be considered as a differential diagnosis in cases of polycystic liver disease in cats, especially in countries with tropical or subtropical climate. Early diagnosis and appropriate treatment were fundamental for the improvement of the patient's clinical condition.

Eosinophilic folliculitis in a dog

Background: Canine eosinophilic folliculitis is a dermatological disease of acute onset with development of erosive to ulcerative papular lesions, especially on the nasal bridge, that may cause severe skin abnormalities leading to discomfort and pain to the patient. The aim of this report was to characterize a case of a canine eosinophilic folliculitis with papular, ulcerative and crusting dermatitis on the nasal bridge, papules on eyelid and pinna, with confirmed diagnosis based on aspiration cytology, history and response to immunosuppressive therapy with glucocorticoid. Case: An 1-year-old intact Daschund was attended showing an acute onset (over 4 h) of generalized urticarial reaction and nonpruriginous lesion at the muzzle with mild serosanguineous exudate, which persisted for 96 h when the dog was evaluated. It was observed a papular and ulcerative dermatitis with serosanguineous exudate and hematic crusts at nasal bridge, papules measuring 2 mm in diameter in the medial and lateral canthus of the left eyelid, ulcerative papule with hematic crust in the border of left ear pinna, multifocal papules on the skin, dyskeratosis and generalized hair loss. The patient was anesthetized for blood sampling (CBC and serum biochemistry), lesions fine-needle aspiration, scraping and imprint for cytological examination, bacterial culture and nasal turbinates radiography. Fragments for histopathological evaluation were also collected. Erythrogram and platelet evaluation were unremarkable. Leukogram revealed leukocytosis (neutrophilia, lymphocytosis, monocytosis and eosinophilia). Serum biochemistry revealed hyperalbuminemia and discrete hyperproteinemia; values of alanine aminotransferase, creatinine and globulins were within normal range. In cytological examination, intense cellularity was observed with predominance of eosinophils (60%), neutrophils (35%), macrophages performing cytophagocytosis (5%) and degenerated cells. There was no bacterial growth within 48 h after incubation of nasal bridge lesion swab. There were no abnormalities identified at radiographic evaluation of nasal turbinates. As the patient was already with antibiotic therapy and steroidal anti-inflammatory, it was opted to maintain it, since interruption between the day of examination and laboratory results could cause more prejudice than benefit, corticosteroid dose, however, was readjusted (prednisone 2 mg/kg/per os/every 24h). After 1 week of treatment the owner reported significant improvement of clinical signs without any further complaint. Discussion: Typically, type I hypersensitivity reactions such as insect bites do not exceed clinical signs of erythema, local edema and pruritus, with spontaneous remission of clinical signs within few hours after exposure to the antigen. Eosinophilic folliculitis, however, may cause more severe clinical alterations, such as pain, apathy and hyporexia. Nasal bridge is the predominant site described to be affected in cases of eosinophilic folliculitis, being auricular pinna, thorax and limbs considered atypical presentations which can delay proper diagnosis, since in endemic regions for diseases such as visceral leishmaniasis, infectious etiology may be listed first. Differential diagnosis also includes superficial pyoderma, juvenile cellulitis, pemphigus foliaceus and pharmacodermia. The case described in this report emphasize the importance of an accurate diagnosis as well as an early and adequate treatment in order to promote satisfactory response. Also, highlights inadequate use of antimicrobials as a direct consequence of lack of laboratorial investigation.

Management of urethral obstruction in a cat with epidural sacrococcygeal anesthesia guided by electrical neurostimulation

Background: The treatment for urethral obstruction in cats consists of catheterization, and for this, the cat must be sedated or anesthetized. Sacococcygeal epidural block has the advantage of being close to receptors related to nociception located in the spinal cord and it is safer because it represents lower risk of spinal cord injury or inadvertent application in the subarachnoid space, when compared to the lumbosacral epidural. Nerve stimulation through the neurolocator to identify the epidural space increases the accuracy of this technique. Thus, the objective is to report a case of epidural anesthesia with a sacrococcygeal approach guided by neurostimulation in a cat with urethral obstruction. Case: A 4-year-old male Siamese cat, weighing 4 kg, was referred to the veterinary care with a history of apathy and anorexia for 2 days. From the physical exam, the clinical diagnosis of urethral obstruction was made, and to desobstruction, we chose to perform sacrococcygeal epidural block. Initially, the patient was anesthetized with propofol (4 mg/kg) and midazolam (0.3 mg/kg). To perform the anesthetic block, the cat was placed in sternal decubitus with the hind limbs extended cranially to perform sacrococcygeal epidural block. The positive pole (cathode) was connected to the skin of the right inguinal region at the caudal aspect of the thigh and the neurostimulator was turned on and adjusted to 0.7 mA of stimulating current intensity, 0.1 ms duration and 1 Hz frequency. The needle for electrical neurolocation was introduced in the dorsal midline, perpendicular to the skin surface, between the spinous processes of S3-Cd1 in the skin. The exact injection point was obtained observed by the muscular response of the middle and distal third of the animal's tail with the neurostimulator adjusted to 0.3 mA of intensity, in the same duration and frequency as before. The total volume of 0.9 mL (0.22 mL/kg) of solution containing the combination of 0.6 mL of 0.75% levobupivacaine and 0.3 mL of 2% lidocaine was injected. The success of the block was confirmed by the loss of reflexes of the pelvic limbs and anal sphincter 10 min after the administration of the anesthetic solution. Discussion: In this case, the use of the neurolocator helped to perform an effective sacrococcygeal block, allowing urethral catheterization without the addition of other analgesic agents. This technique desensitizes and relaxes muscles in the regions of the perineum, anus, distal colon and penis, being useful for performing urethral catheterization. The use of smaller anaesthetic volumes to perform sacrococcygeal block makes it possible to achieve a more localized anesthesia, without affecting the motor function of the pelvic limbs. However, in our report, using a combination of levobupivacaine and lidocaine, the pelvic limb block was also verified despite the low volume applied. A hypothesis that could justify the different responses in relation to the pelvic limb block compared to other studies would be due to the different physicalchemical properties of the drugs used. Lidocaine is known to be less fat-soluble than bupivacaine, so it tends to spread more through the epidural space, in order to result in more extensive blocks. The use of a neurostimulator using a fixed electric current of 0.7 mA, pulse 0.1 ms and a frequency of 1 Hz allowed the correct identification of the needle position for the application of the anesthetic.

Non-epitheliotropic cutaneous lymphoma with systemic dissemination in a dog

Background: Cutaneous lymphoma is a highly malignant neoplasm, which can originate in the epidermis or dermis, aswell as be disseminated to other organs such as lung, heart, arm, liver and bone marrow. It comes in the form of nodes ofvarious sizes, erythematous and alopecic, itching may or may not occur. The diagnosis is made by cytological and histopathological examination of the compromised tissue. However, it is important to perform complementary tests for clinicalstaging and prognostic characterization. The objective is to report a case of non-epitheliotropic cutaneous lymphoma withsystemic dissemination in a dog.Case: A female mixed bred adult canine was attended at the Veterinary Hospital of the Federal University of Mato Grossodo Sul with a history of progressive weight loss and the presence of alopecic and non-pruritic subcutaneous nodules in thetorso, nasal plane and pelvic limbs, starting 4 months ago. After approximately 20 days, the presence of rapidly evolvingulcerated nodules was noted. On physical examination, generalized lymphadenomegaly was observed and among thedermatological findings were multiple nodules of varying sizes with the presence of ulceration in the center of the lesions,alopecia, erythema and raised edges, in the region of the nasal sinus, pelvic and thoracic limbs, tail, thoracolumbar andabdominal region. The animal also presented right pelvic limb edema with painful sensibility to manipulation CBC andbiochemical tests (albumin, alanine aminotransferase, creatinine, urea, alkaline phosphatase, globulins, total proteins andfractions) were performed, being observed as normocytic normochromic type anemia alteration (erythrocytes: 2.78 106/µL; hemoglobin: 6.8 g/µL; globular volume: 18.8%), leukopenia (4,000/mm3) with presence of metamyelocytes (120/mm3) and rods (1,080/mm3) and lymphopenia (80/mm3). Three samples of the nodules were...

Squamous cell carcinoma in the third eyelid of a dog

Background: Squamous cell carcinoma is a malignant neoplasm that originates from the keratinized stratified squamous epithelium and predominantly affect light-skinned animals. In dogs, breeds such as American Staffordshire Terriers, white or speckled Bull Terriers, and Beagles have a higher predisposition. Squamous cell carcinoma presents in the skin, at slightly pigmented or hairy sites, especially in digits, but also may occur in the nasal planum, oral mucosa, and rarely, in the eye. Considering that few reports have been published on eye neoplasms, the aim of this paper is to describe a dog with a lesion in the third eyelid of his right eye which was diagnosticated with squamous cell carcinoma. Case: A 10-year-old male American Staffordshire dog was admitted to the Veterinary Medical Teaching Hospital of the Veterinary Medicine and Zootechnics College, Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Brazil with injury to the right eye. During the physical examination, there was also a non-adhered lump near the foreskin, measuring 1.5 cm in diameter. In addition, there was another lump in the third eyelid of the right eye, approximately 3 mm in diameter. Cytology of the dermal nodule was performed by fine-needle aspiration cytology; however, the sample was insufficient for cytological evaluation. Therefore, the animal was placed under general anesthesia for skin lump excision and for fine-needle aspiration cytology of the third eyelid nodule. The histopathological exam revealed high cellularity of epithelial cells, intense anisocytosis and pleomorphism, cytoplasmic basophilia and vacuolation, multiple evident nucleoli, and anisocariosis and coarse chromatin. These finds were compatible with squamous cell carcinoma, which was the same result suggested by fine-needle aspiration cytology of the third...

Seroprevalence of Toxoplasma gondii, Neospora caninum, and Leishmania spp. in hunting dogs from Mato Grosso do Sul, Brazil / Soroprevalência de Toxoplasma gondii, Neospora caninum e Leishmania spp. em cães de caça do Mato Grosso do Sul, Brasil

Toxoplasmosis, neosporosis, and leishmaniasis are important diseases of worldwide distribution and can affect both pets and humans. Hunting dogs have been trained to hunt domestic and wild animals, which makes them more exposed to parasitic infections. The present study aimed to evaluate the seroprevalence of Toxoplasma gondii, Neospora caninum, and Leishmania spp. in hunting dogs from a rural area in Mato Grosso do Sul, Brazil. Serum samples were collected from 39 American Foxhound dogs, and the sex and age variables were recorded. Serum samples were subjected to an indirect fluorescent antibody test (IFAT) to detect antibodies. Seroprevalence was 35.9%, 15.4%, and 2.6% for Toxoplasma gondii, Neospora caninum e Leishmania spp., respectively. There was no statistical difference between genders for these diseases (P>0.05). Results demonstrated a circulation of these protozoa in hunting dogs in a rural area of the state of Mato Grosso do Sul, which can contribute to the epidemiology of these diseases.(AU)

Toxoplasmose, neosporose e leishmaniose são importantes doenças de distribuição mundial e podem afetar tanto os animais de companhia quanto os humanos. Os cães de caça têm sido treinados para caçar animais domésticos e selvagens, o que torna esses animais mais expostos a infecções parasitárias. O presente estudo teve como objetivo avaliar a soroprevalência de Toxoplasma gondii, Neospora caninum e Leishmania spp. em cães de caça de área rural do Mato Grosso do Sul, Brasil. Foram coletadas amostras de soro de 39 cães da raça Foxhound-americano e as variáveis sexo e idade foram registradas. As amostras de soro foram submetidas a reação de imunofluorescência indireta (RIFI) para detecção dos anticorpos. A soroprevalência foi de 35,9%, 15,4% e 2,6% para Toxoplasma gondii, Neospora caninum e Leishmania spp., respectivamente. Não foi observado diferença estatística entre os sexos para todas as doenças (P>0.05). Os resultados demonstram circulação desses protozoários em cães de caça de uma área rural do estado do Mato Grosso do Sul, o que pode contribuir para a epidemiologia dessas doenças.(AU)

Non-epitheliotropic cutaneous lymphoma with systemic dissemination in a dog

Background: Cutaneous lymphoma is a highly malignant neoplasm, which can originate in the epidermis or dermis, aswell as be disseminated to other organs such as lung, heart, arm, liver and bone marrow. It comes in the form of nodes ofvarious sizes, erythematous and alopecic, itching may or may not occur. The diagnosis is made by cytological and histopathological examination of the compromised tissue. However, it is important to perform complementary tests for clinicalstaging and prognostic characterization. The objective is to report a case of non-epitheliotropic cutaneous lymphoma withsystemic dissemination in a dog.Case: A female mixed bred adult canine was attended at the Veterinary Hospital of the Federal University of Mato Grossodo Sul with a history of progressive weight loss and the presence of alopecic and non-pruritic subcutaneous nodules in thetorso, nasal plane and pelvic limbs, starting 4 months ago. After approximately 20 days, the presence of rapidly evolvingulcerated nodules was noted. On physical examination, generalized lymphadenomegaly was observed and among thedermatological findings were multiple nodules of varying sizes with the presence of ulceration in the center of the lesions,alopecia, erythema and raised edges, in the region of the nasal sinus, pelvic and thoracic limbs, tail, thoracolumbar andabdominal region. The animal also presented right pelvic limb edema with painful sensibility to manipulation CBC andbiochemical tests (albumin, alanine aminotransferase, creatinine, urea, alkaline phosphatase, globulins, total proteins andfractions) were performed, being observed as normocytic normochromic type anemia alteration (erythrocytes: 2.78 106/µL; hemoglobin: 6.8 g/µL; globular volume: 18.8%), leukopenia (4,000/mm3) with presence of metamyelocytes (120/mm3) and rods (1,080/mm3) and lymphopenia (80/mm3). Three samples of the nodules were...(AU)

Black hair follicular dysplasia in a fox paulistinha dog: clinical and histopathological features / Displasia folicular do pelo preto em um cão Fox paulistinha–características clínicas e histopatológicas

Black hair follicular dysplasia (BHFD) is an unusual canine skin disorder defined as alopecia confined to black regions of the hair coat. First clinical abnormalities are usually noted around four weeks of age and comprise fracture of hair shafts in black-coated regions, later resulting in partial alopecia, usually, on the head, ear pinnae, neck, and back, whereas some nonblack-coated areas may exhibit normal hair. The diagnosis is confirmed by histopathologic features. This article aims to report a case of black hair follicular dysplasia in a seven-month-old Fox Paulistinha male dog showing alopecia restricted to black-haired areas, in which diagnosis was confirmed by histopathological exams that showed follicular dysplasia associated with melanic accumulation in the hair shaft and in and deep dermal tissue.

A displasia folicular do cabelo preto (BHFD) é uma doença incomum da pele canina definida como alopecia confinada a regiões de pelo preto. As primeiras anormalidades clínicas são geralmente notadas em torno de quatro semanas de idade e compreendem fratura dos pelos em regiões cobertas de pelagem preta, resultando posteriormente em alopecia parcial, geralmente, na cabeça, orelha, pescoço e dorso, enquanto algumas áreas cobertas por pelos que não são pretos, podem ser normais. O diagnóstico é confirmado por características histopatológicas. Este artigo tem como objetivo relatar um caso de displasia folicular do pelo preto em um cão macho Fox Paulistinha de sete meses de idade mostrando alopecia restrita a áreas de pelos pretos, em que o diagnóstico foi confirmado por exames histopatológicos que mostraram displasia folicular associada ao acúmulo melânico no folículo piloso e no tecido dérmico profundo.