A day in the life of a dermatologist - Difficult cases (Parts 1 and 2) (Proceedings)

The following mystery cases will be analyzed from initial presentation to the final diagnosis, treatment, and follow up.

Case #1

Signalment : 10 month old, SF, DSH

History: Two month history of pruritus with a partial response to corticosteroids. Selamectin has been used monthly. There is another cat in the house that is nonpruritic.

Diagnostics: Impression smears, skin scrapings, trichogram, Woods lamp, fungal culture

Diagnosis:

Treatment:

Case #2

Signalment: 5 year old, CM Australian Shepherd cross

History: Has had ear infections for 9 months as well as scaly skin on the trunk. Many different otic medications and flushes have been used without improvement.

Diagnostics (initial): Ear cytology, Skin scraping, Bloodwork.

Diagnosis:

Treatment:

Case #3

Signalment: 3 year old, CM boxer

History: Nonpruritic nodules on the head for the last 3 months.

Differential Diagnoses: Mast cell tumors, Histiocytic tumors, Lymphoma, foreign body reaction, sterile pyogranuloma, infectious granuloma

Diagnostics: Cytology, histopathology, special stains

Diagnosis:

Treatment:

Case #4

Signalment: 4 year old, SF coyote cross

History: The first lesion started on the nose while in Arizona seven months prior to referral. At that time it had been diagnosed as solar dermatitis and had responded to prednisone and antibiotics. The lesions then spread over the face and body. Recently, there was no improvement with enrofloxacin and a methylprednisolone acetate injection.

Differential Diagnosis: Systemic lupus erythematosus, Pemphigus foliaceus, vasculitis

Diagnostics: Impression smears, skin scrapings, bloodwork, histopathology

Diagnosis:

Treatment:

Case #5

Signalment: 9 year old, CM DSH

History: One week prior to referral the cat had been seen by the RDVM for a bleeding claw that was thought to have been injured. This claw was removed surgically. Preoperative bloodwork was WNL. Four days after surgery, more digits were becoming affected. Referral was made at that time.

Diagnostics: Cytology, radiographs

Diagnosis:

Treatment:

Case #6

Signalment: 6 year old, CM, mixed breed dog

History: Had been adopted 1 year ago and has had ear problems since adoption. Ears are nonpruritic and have a green-colored discharge AU. Initial cytology showed many white blood cells and very few cocci. Tympanic membranes were not able to be visualized.

Diagnostics: Cytology, video otoscopy, CT

Diagnosis:

Treatment:

Case #7

Signalment: 11 year old, CM, Sheltie

History: Has had a pruritic lesion on one leg for more than 1 year. The lesion started below the elbow and spread to the foot. He is not bearing weight on the leg. Leg muscles have contracted and we are unable to extend the leg. There has been no response to amoxicillin/clavulanic acid or prednisone.

Diagnostics: Radiographs, Skin biopsy, tissue cultures (fungal, mycobacterial, aerobic/anaerobic bacteria).

Diagnosis:

Treatment:

Case #8

Signalment: 4 year old, SF, Jack Russel terrier

History: Four to five month history of severe facial pruritus. Pathologist's interpretation of the skin biopsy was pemphigus foliaceus. Poor response to prednisone at immunosuppressive doses.

Diagnostics: Deep skin scrapings, cytology, fungal culture

Diagnosis:

Treatment:

Case #9

Signalment: 12 year old, SF, Persian

History: Three month history of crusted papules and scaling on the ventral neck. Previous skin biopsy was non-diagnostic. No response to oral antibiotics.

Diagnostics: Skin biopsy

Diagnosis:

Treatment:

Case #10

Signalment: 3 year old, CM, Golden Retriever

History: Vesicles, crusts and erosions of the skin of the face, pinnae and lips for one month. No prior treatments.

Diagnostics: Cytology, Skin biopsy

Diagnosis:

Treatment:

Case #11

Signalment: 5 year old, CM, St. Bernard.

History: Several month history of nasal ulcer with acute episode of hemorrhage.

Diagnostics: Skin biopsy

Diagnosis:

Treatment: