Veterinary Medicine - March 2008 - (Page 146)

PEER-REVIEWED A challenging case: Glucagonoma-associated superficial necrolytic dermatitis in a dog Although this skin disease is usually associated with hepatopathy, in this dog the lesions had a more uncommon cause. Kurt L. Zimmerman, DVM, PhD; Shawn P. Clark, DVM, PhD, DACVP; Kate Hill, BVSc(Hons), DACVIM; Peter Laverty, BVSc, MACVSc, DACVS; Armando Irizarry, DVM, PhD, DACVP; Tanya LeRoith, DVM, PhD, DACVP; and Dennis DeNicola, DVM, PhD, DACVP Vital Stats Signalment An 8-year-old 46.3-lb (21-kg) female spayed mixed-breed dog A n 8-year-old 46.3-lb (21-kg) female spayed mixed-breed dog was referred to the Purdue University Veterinary Teaching Hospital for evaluation of lethargy, inappetence, weight loss, and alopecia of several months’ duration (Figure 1). PHYSICAL EXAMINATION At presentation, the dog was in poor body condition, with a score of 3/9. The dog’s temperature and pulse and respiration rates were normal. The physical examination revealed erythema, ulcers, and super cial excoriations involving the footpads (Figure 2) and ventral interdigital areas, extending to the tarsus and carpus. Similar lesions were noted on the elbows, hocks (Figure 3), ears, and commissures of the mouth. No other abnormalities were identi ed on oral examination, abdominal palpation, or thoracic auscultation. Differential diagnoses considered at this point included various autoimmune, hypersensitivity, and paraneoplastic dermatitides; erythema multiforme; toxic epidermal necrolysis; various cutaneous neoplasms; canine distemper-associated hyperkeratosis; and nutritional disorders such as zinc de ciency. Presenting complaints • Lethargy • Inappetence and weight loss • Alopecia Physical examination ﬁndings • Erythema • Ulcers and superﬁcial excoriations on the footpads and ventral interdigital areas, extending to the tarsus and carpus • Similar lesions on the elbows, hocks, ears, and commissures of the mouth Initial suspicions • Various dermatitides • Erythema multiforme • Toxic epidermal necrolysis • Various cutaneous neoplasms • Canine distemper-associated hyperkeratosis skin revealed severe, chronic, and regionally diffuse acanthosis with intracellular edema in the stratum spinosum, parakeratosis and crusting, and super cial lymphohistiocytic dermatitis, suggestive of super cial necrolytic dermatitis and glucagonoma-associated paraneoplastic syndrome (Figure 4). A radiographic examination revealed slightly decreased liver and cardiac silhouettes but no abdominal masses. An ultrasonographic examination did not reveal any spaceoccupying abdominal masses or abnormal hepatic echotexture. To explore possible causes of the super cial necrolytic dermatitis, such as hepatic de ciency or a pancreatic glucagonoma, fasting blood samples were submitted for a complete blood count (CBC), serum chemistry pro le, and plasma glucagon concentration. A bile acid assay was also done. The CBC did not reveal any clinically relevant hematologic abnormalities, and the serum chemistry pro le revealed only mildly decreased blood urea nitrogen (4 mg/dl; reference interval = 5 to 28 mg/dl) and creatinine (0.4 mg/dl; reference interval = 0.5 to 1.5 mg/dl) concentrations, attributed to the poor body condition score and associated reduced muscle mass. Please see page 153 for author information. • Nutritional disorders DIAGNOSTIC TESTING Histologic examination of biopsy samples from the footpads and adjacent haired 146 March 2008 VETERINARY MEDICINE ©iStockphoto.com/Tamara Murray

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Veterinary Medicine - March 2008 Contents Toxicology Brief Idea Exchange A Challenging Case An Update on Diagnosing and Treating Primary Lung Tumors CE Form Product Preview Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - March 2008

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