Eritema multiforme e suas características clínico-patológicas em um equino no Brasil / Erythema multiforme and its clinicopathological features in a horse in Brazil

Background: Erythema multiforme (EM) is an immune-mediated skin disease which may manifest as cutaneous or mucocutaneous lesions. It is uncommon in horses. EM lesions have a symmetrical bilateral distribution; they are usually urticarial, necrotizing, and, less commonly, ulcerative. In equines, the trigger is usually unknown, and cases are often classified as idiopathic. Diagnosis is based on a thorough history and physical and histopathological examination of lesions. According to the clinical presentation and histopathological characteristics of the cutaneous lesions, this case is the first report to describe diagnosis and treatment of a horse with EM in Brazil. Case: A Quarter Horse filly was followed clinically for 12 months after sudden onset of skin lesions at 18 months of age. The initial lesions were non-alopecic papules with a symmetrical bilateral distribution. Six months after onset, the skin lesions maintained the original distribution pattern; however, they had progressed to papules and plaques with varying annular, arciform, serpiginous, targetoid, or alopecic appearance. At 8 months, the same distribution pattern and appearance remained, but the lesions had become more severe and extensive, with involvement of the labial commissures and perineal region, without any erosions/ulcerations, scaling/crusting, pain, or pruritus. At 12 months, new nodular lesions were found on the medial and lateral surfaces of the hind limbs, neck, bilateral trunk, and root of the tail. The lesions were firm, non-pruritic, and non-tender on palpation. Swabs were obtained from the papular lesions. Skin specimens were also obtained with a 6-mm punch and via incisional biopsy and histological sections were made. Bacterial and fungal cultures were negative. Appropriate stains did not identify fungal structures, were negative for acid-fast bacilli, and did not reveal any metachromatic granules in the sampled cell population. The histopathological findings were characteristic of immune-mediated disease, with a vacuolar interface dermatitis affecting the hair follicles more than the epidermis, necrotic keratinocytes, lymphocyte satellitosis, leukocytoclastic mixed vasculitis of the mid-dermis and deep dermis, and variable granulation tissue, consistent with erythema multiforme and leukocytoclastic vasculitis. Immunosuppressive therapy with corticosteroids and oral supplementation with omega-3 and omega-6 fatty acids and vitamin E were prescribed. After institution of therapy, no new lesions developed, the existing lesions remained stable (though permanent), and hair regrew in the previously alopecic areas. All physiological parameters remained normal throughout the follow-up period. Discussion: Erythema multiforme is rarely reported in horses. According to our literature review, this is the first description of EM in horses in Brazil. EM should be included in the differential diagnosis of horses that present with plaques in a diverse, geographic distribution and a negative initial dermatological screening examination. Further clinical investigation is warranted, with special attention to potential antigenic triggers. A thorough drug and dietary history and close attention to comorbidities are essential, as the suppression of potential culprit factors has important prognostic value and contributes to the elucidation of EM triggers.(AU)

Treatment of discoid lupus erythematosus in a dog with human intravenous immunoglobulin

Background: Discoid lupus erythematosus (DLE) is a common canine autoimmune skin disease, in which systemic manifestations are absent. Skin Lesions are usually present on the nasal planum, and characterised by erythema, depigmentation, erosion, ulceration, and crusting. The diagnosis is based on histopathological results, which should demonstrate lymphoplasmacytic lichenoid-interface dermatitis. Human intravenous immunoglobulin (hIVIg) has been used in veterinary medicine to treat cutaneous diseases including erythema multiforme, PF, and severe adverse cutaneous drug reactions. In human medicine, it has been effective to treat DLE. This report firstly describes the clinical response to hIVIg in a dog with DLE resistant to common immunosuppressive drugs. Case: A 5-year-old, intact female Shih Tzu presented with a 1-month history of slowly progressive black crusting on the nasal planum, chin, and claw. Based on the results of a dermatologic examination, superficial pyoderma was diagnosed. The skin lesions did not improve during and after anti-infective treatment. After removing the crusts, a skin biopsy was obtained from the muzzle. Histopathology of lesional skin biopsy specimens revealed lymphoplasmacytic interface dermatitis at the dermoepidermal junction. Microscopic examination also revealed vacuolar changes and pigmentary incontinence of the basal layer as a lichenoid tissue reaction. No mites or fungi were detected on the skin section. The absence of acantholytic cells excluded pemphigus foliaceus, which is also characterised by the lesions of the nasal planum. Based on the distribution of the lesions, histopathology and exclusion of other dermatoses, the dog was diagnosed with DLE. The skin lesions temporarily improved after treatment with prednisolone (2 mg/kg PO q12h). However, after tapering the dose of prednisolone, new black crusts developed on the nasal planum and claw. Although the dog was successively treated with other immunosuppressive drugs, including azathioprine, cyclosporin with dexamethasone, and mycophenolate mofetil, black crusts still remained. Due to the low efficacy of these immunosuppressive drugs, hIVIg was administered at 0.5 g/kg once daily for 4 days, for a total dose of 2 g/kg. During hIVIg administration, the crusted lesions gradually improved. After the hIVIg administration, the dog was treated with prednisolone (1 mg/kg PO q12h). The lesions were almost in complete remission at 21 days after an additional application of prednisolone. The skin lesions did not recur, and the treatment was eventually discontinued after 6 weeks of additional prednisolone application. Discussion: The standard treatment of canine DLE includes glucocorticoids, and second-line immunosuppressive drugs, such as azathioprine and cyclosporine, are usually added in cases resistant to steroids. This case suggests that hIVIg may be beneficial as an adjunctive treatment option for canine DLE, especially when the application of standard immunosuppressive drugs is limited due to adverse effects or low efficacy. There is evidence from several studies that the steroid-sparing effect of hIVIg is significant in human patients. In the current case, the effective dose of prednisolone was reduced to 2 mg/kg/day after hIVIg administration, and prednisolone therapy was finally discontinued completely. The hIVIg appears to lower the daily steroid dose requirement in this dog.

Eritema multiforme limitado à cavidade oral em um cão: relato de caso / Multiforme erythema limited to the oral cavity in a dog: case report

O eritema multiforme é uma doença incomum em cães, que afeta pele e mucosas, cuja etiologia ainda não foi completamente elucidada. Contudo, o envolvimento exclusivo da cavidade oral é considerado raro, tendo sido descrito poucas vezes até o presente momento. O objetivo deste trabalho é descrever um caso de eritema multiforme limitado à cavidade oral em um canino. Um cão, fêmea, Akita, com sete anos de idade, apresentou histórico de ulcerações na cavidade oral e nas laterais da língua, sem alterações cutâneas ou sistêmicas. O diagnóstico definitivo foi realizado por meio do exame histopatológico da mucosa oral, e a terapia imunossupressora empregada mostrou-se eficaz. Embora o eritema multiforme seja considerado incomum na espécie canina, este relato de caso apresenta a forma mais rara da doença, com poucos casos descritos em medicina veterinária.(AU)

Multiforme erythema is an uncommon disease in dogs that affects the skin and mucous membranes, the etiology of which has not yet been fully elucidated. However, the exclusive involvement of the oral cavity is considered rare, having been described few times until the present moment. The aim of this work is to describe a case of multiforme erythema limited to the oral cavity in a canine. A seven-year-old female dog, akita, presented a history of ulcerations in the oral cavity and on the sides of the tongue, with no cutaneous or systemic changes. The definitive diagnosis was made through the histopathological examination of the oral mucosa and the immunosuppressive therapy used proved to be effective. Although multiforme erythema is considered uncommon in the canine species, this case report presents the rarest form of the disease, with few cases described in veterinary medicine.(AU)

Eritema multiforme limitado à cavidade oral em um cão: relato de caso / Multiforme erythema limited to the oral cavity in a dog: case report

O eritema multiforme é uma doença incomum em cães, que afeta pele e mucosas, cuja etiologia ainda não foi completamente elucidada. Contudo, o envolvimento exclusivo da cavidade oral é considerado raro, tendo sido descrito poucas vezes até o presente momento. O objetivo deste trabalho é descrever um caso de eritema multiforme limitado à cavidade oral em um canino. Um cão, fêmea, Akita, com sete anos de idade, apresentou histórico de ulcerações na cavidade oral e nas laterais da língua, sem alterações cutâneas ou sistêmicas. O diagnóstico definitivo foi realizado por meio do exame histopatológico da mucosa oral, e a terapia imunossupressora empregada mostrou-se eficaz. Embora o eritema multiforme seja considerado incomum na espécie canina, este relato de caso apresenta a forma mais rara da doença, com poucos casos descritos em medicina veterinária.(AU)

Multiforme erythema is an uncommon disease in dogs that affects the skin and mucous membranes, the etiology of which has not yet been fully elucidated. However, the exclusive involvement of the oral cavity is considered rare, having been described few times until the present moment. The aim of this work is to describe a case of multiforme erythema limited to the oral cavity in a canine. A seven-year-old female dog, akita, presented a history of ulcerations in the oral cavity and on the sides of the tongue, with no cutaneous or systemic changes. The definitive diagnosis was made through the histopathological examination of the oral mucosa and the immunosuppressive therapy used proved to be effective. Although multiforme erythema is considered uncommon in the canine species, this case report presents the rarest form of the disease, with few cases described in veterinary medicine.(AU)

Eritema multiforme em cão / Erythem a multiforme in a dog

O eritema multiforme é uma doença incomum na prática dermatológica de pequenos animais e se manifesta como uma desordem inflamatória caracterizada por lesões de diferentes apresentações em pele e/ou mucosas. Acredita-se que esta dermatopatia em cães seja mais comumente associada à hipersensibilidade medicamentosa, e, em menor escala, relacionada a neoplasias, infecções e idiopática. O objetivo do presente artigo é relatar um caso de Eritema Multiforme (EM) num canino, fêmea, sem raça definida, com doze anos de idade, apresentando problemas na pele e conduto auditivo durante um período anterior de três meses. As lesões tinham aspectode placas eritematosas com centro mais claro, em forma de alvo, envolvendo pele e mucosas; os condutos auditivos apresentavam secreção purulenta abundante. Após o diagnóstico clínicopresuntivo de EM, foi realizado exame histopatológico que confirmou a suspeita. O animal recebeu corticoterapia sistêmica e medicação otológica tópica apresentando remissão significativa das lesões. (AU)

Erythema multiforme is an uncommon disease in small animal dermatology practice and occurs as an inflammatory disorder characterized by different presentations skin and/or mucousmembranes injuries.It is believed that this skin disease in dogs is usually drug hypersensitivity associated, and to a lesser extent, related to cancer, infections, and idiopathic. This paper aims to report an erythema multiforme case in a female, mixed breed, with twelve years old dog with skin and ear disorders for about three months. Lesionss appearance were erythematous plaques with central ligther-shaped target, involving skin and mucous membranes. The auditive canalhad abundant purulent secretion. After the presumptive clinical diagnosis of Erythema multiforme, histopathologic examination has performed which confirmed the suspicion. The animalreceived oral corticosteroids and topical ear medication that resulted in significant remission of the lesions. (AU)

Eritema multiforme em cão / Erythem a multiforme in a dog

O eritema multiforme é uma doença incomum na prática dermatológica de pequenos animais e se manifesta como uma desordem inflamatória caracterizada por lesões de diferentes apresentações em pele e/ou mucosas. Acredita-se que esta dermatopatia em cães seja mais comumente associada à hipersensibilidade medicamentosa, e, em menor escala, relacionada a neoplasias, infecções e idiopática. O objetivo do presente artigo é relatar um caso de Eritema Multiforme (EM) num canino, fêmea, sem raça definida, com doze anos de idade, apresentando problemas na pele e conduto auditivo durante um período anterior de três meses. As lesões tinham aspectode placas eritematosas com centro mais claro, em forma de alvo, envolvendo pele e mucosas; os condutos auditivos apresentavam secreção purulenta abundante. Após o diagnóstico clínicopresuntivo de EM, foi realizado exame histopatológico que confirmou a suspeita. O animal recebeu corticoterapia sistêmica e medicação otológica tópica apresentando remissão significativa das lesões.

Erythema multiforme is an uncommon disease in small animal dermatology practice and occurs as an inflammatory disorder characterized by different presentations skin and/or mucousmembranes injuries.It is believed that this skin disease in dogs is usually drug hypersensitivity associated, and to a lesser extent, related to cancer, infections, and idiopathic. This paper aims to report an erythema multiforme case in a female, mixed breed, with twelve years old dog with skin and ear disorders for about three months. Lesions’s appearance were erythematous plaques with central ligther-shaped target, involving skin and mucous membranes. The auditive canalhad abundant purulent secretion. After the presumptive clinical diagnosis of Erythema multiforme, histopathologic examination has performed which confirmed the suspicion. The animalreceived oral corticosteroids and topical ear medication that resulted in significant remission of the lesions.

Incidence of the autoimmune dermatosis in dogs and cats and retrospective study of 40 cases of discoid lupus erythematosus attended at the Dermatology Service of the College of Veterinary Medicine and Animal Science of UNESP Botucatu / Incidência das dermatopatias auto-imunes em cães e gatos e estudo retrospectivo de 40 casos de lupus eritematoso discóide atendidos no serviço de dermatologia da Faculdade de Medicina Veterinária e Zootecnia da UNESP Botucatu

The objectives of this study were to do a survey of the autoimmune skin diseases and update the records regarding the occurrence of discoid lupus erythematosus in canine and feline populations attended at the Dermatology Service of the College of Veterinary Medicine and Animal Science of UNESP - Botucatu, including species, gender, breed, age, location and characteristic of the lesions. Results have shown that the order of occurrence, regarding the number of cases of  autoimmune skin diseases in the animals attended by the Dermatology Service in the period from 1988 to 2007 was: discoid lupus erythematosus, pemphigus folliaceus, uveo-dermatologic syndrome, pemphigus vulgaris, systemic lupus erythematosus, necrolytic migratory erythema, multiforme erythema and plasmacytic pododermatitis. All the animals with discoid lupus erythematosus were dogs and most of them were mongrel females. More frequently breeds affected by discoid lupus erythematosus were german shepherd and akita and the mean age was 56 months. Most lesions were located in nasal planum, narines and periocular area and were characterized by crusting, depigmentation and erythema.

Os objetivos do presente trabalho teve como objetivo fazer um levantamento da casuística de doenças dermatológicas auto-imunes e atualizar os dados referentes à ocorrência de lupus eritematoso discóide na população canina e felina atendida pelo Serviço de Dermatologia Veterinária da FMVZ-UNESP, campus de Botucatu, incluindo a espécie, sexo, raça, idade, localização e caracterização das lesões. Com a análise dos resultados, concluiu-se que a ordem de ocorrência de acordo com o número de casos de doenças dermatológicas auto-imunes nos animais atendidos pelo setor de dermatologia no período de 1988 a 2007 é: lupus eritematoso discóide, pênfigo foliáceo, síndrome úveo-dermatológica, pênfigo vulgar, lupus eritematoso sistêmico, eritema necrolítico migratório, eritema multiforme e pododermatite plasmocitária. Dos animais com lupus eritematoso discóide, todos eram da espécie canina, sendo a maioria fêmea e sem definição racial. As raças mais acometidas por lupus eritematoso discóide foram: Pastor Alemão e Akita e a média das idades foi de 56 meses. Notou-se que a maioria das lesões era localizada em plano nasal, narinas e região periocular. As lesões mais comumente observadas foram: crosta, despigmentação e eritema.

Incidence of the autoimmune dermatosis in dogs and cats and retrospective study of 40 cases of discoid lupus erythematosus attended at the Dermatology Service of the College of Veterinary Medicine and Animal Science of UNESP – Botucatu / Incidência das dermatopatias auto-imunes em cães e gatos e estudo retrospectivo de 40 casos de lupus eritematoso discóide atendidos no serviço de dermatologia da Faculdade de Medicina Veterinária e Zootecnia da UNESP – Botucatu

The objectives of this study were to do a survey of the autoimmune skin diseases and update the records regarding the occurrence of discoid lupus erythematosus in canine and feline populations attended at the Dermatology Service of the College of Veterinary Medicine and Animal Science of UNESP - Botucatu, including species, gender, breed, age, location and characteristic of the lesions. Results have shown that the order of occurrence, regarding the number of cases of  autoimmune skin diseases in the animals attended by the Dermatology Service in the period from 1988 to 2007 was: discoid lupus erythematosus, pemphigus folliaceus, uveo-dermatologic syndrome, pemphigus vulgaris, systemic lupus erythematosus, necrolytic migratory erythema, multiforme erythema and plasmacytic pododermatitis. All the animals with discoid lupus erythematosus were dogs and most of them were mongrel females. More frequently breeds affected by discoid lupus erythematosus were german shepherd and akita and the mean age was 56 months. Most lesions were located in nasal planum, narines and periocular area and were characterized by crusting, depigmentation and erythema.

Os objetivos do presente trabalho teve como objetivo fazer um levantamento da casuística de doenças dermatológicas auto-imunes e atualizar os dados referentes à ocorrência de lupus eritematoso discóide na população canina e felina atendida pelo Serviço de Dermatologia Veterinária da FMVZ-UNESP, campus de Botucatu, incluindo a espécie, sexo, raça, idade, localização e caracterização das lesões. Com a análise dos resultados, concluiu-se que a ordem de ocorrência de acordo com o número de casos de doenças dermatológicas auto-imunes nos animais atendidos pelo setor de dermatologia no período de 1988 a 2007 é: lupus eritematoso discóide, pênfigo foliáceo, síndrome úveo-dermatológica, pênfigo vulgar, lupus eritematoso sistêmico, eritema necrolítico migratório, eritema multiforme e pododermatite plasmocitária. Dos animais com lupus eritematoso discóide, todos eram da espécie canina, sendo a maioria fêmea e sem definição racial. As raças mais acometidas por lupus eritematoso discóide foram: Pastor Alemão e Akita e a média das idades foi de 56 meses. Notou-se que a maioria das lesões era localizada em plano nasal, narinas e região periocular. As lesões mais comumente observadas foram: crosta, despigmentação e eritema.

Incidence of the autoimmune dermatosis in dogs and cats and retrospective study of 40 cases of discoid lupus erythematosus attended at the Dermatology Service of the College of Veterinary Medicine and Animal Science of UNESP Botucatu / Incidência das dermatopatias auto-imunes em cães e gatos e estudo retrospectivo de 40 casos de lupus eritematoso discóide atendidos no serviço de dermatologia da Faculdade de Medicina Veterinária e Zootecnia da UNESP Botucatu

The objectives of this study were to do a survey of the autoimmune skin diseases and update the records regarding the occurrence of discoid lupus erythematosus in canine and feline populations attended at the Dermatology Service of the College of Veterinary Medicine and Animal Science of UNESP - Botucatu, including species, gender, breed, age, location and characteristic of the lesions. Results have shown that the order of occurrence, regarding the number of cases of  autoimmune skin diseases in the animals attended by the Dermatology Service in the period from 1988 to 2007 was: discoid lupus erythematosus, pemphigus folliaceus, uveo-dermatologic syndrome, pemphigus vulgaris, systemic lupus erythematosus, necrolytic migratory erythema, multiforme erythema and plasmacytic pododermatitis. All the animals with discoid lupus erythematosus were dogs and most of them were mongrel females. More frequently breeds affected by discoid lupus erythematosus were german shepherd and akita and the mean age was 56 months. Most lesions were located in nasal planum, narines and periocular area and were characterized by crusting, depigmentation and erythema.

Os objetivos do presente trabalho teve como objetivo fazer um levantamento da casuística de doenças dermatológicas auto-imunes e atualizar os dados referentes à ocorrência de lupus eritematoso discóide na população canina e felina atendida pelo Serviço de Dermatologia Veterinária da FMVZ-UNESP, campus de Botucatu, incluindo a espécie, sexo, raça, idade, localização e caracterização das lesões. Com a análise dos resultados, concluiu-se que a ordem de ocorrência de acordo com o número de casos de doenças dermatológicas auto-imunes nos animais atendidos pelo setor de dermatologia no período de 1988 a 2007 é: lupus eritematoso discóide, pênfigo foliáceo, síndrome úveo-dermatológica, pênfigo vulgar, lupus eritematoso sistêmico, eritema necrolítico migratório, eritema multiforme e pododermatite plasmocitária. Dos animais com lupus eritematoso discóide, todos eram da espécie canina, sendo a maioria fêmea e sem definição racial. As raças mais acometidas por lupus eritematoso discóide foram: Pastor Alemão e Akita e a média das idades foi de 56 meses. Notou-se que a maioria das lesões era localizada em plano nasal, narinas e região periocular. As lesões mais comumente observadas foram: crosta, despigmentação e eritema.