Neutrophil-rich toxic epidermal necrolysis in a dog: possible acute generalised exanthematous pustulosis-toxic epidermal necrolysis overlap syndrome

摘要

A four-year-old Staffordshire bull terrier presented with severe and rapidly progressive blistering skin disease, which was consistent clinically with toxic epidermal necrolysis. There had been an acute onset of generalised erythema, pustulosis and blister formation of the ventral abdomen, ventral thorax, axillae and of the oral and vaginal mucosa. Severe pitting oedema was present on the ventral abdomen, distal limbs, face and periocular regions. Dull mentation and inappetance were coincident with the onset of skin lesions. Histopathologic examination of biopsies revealed widespread keratinocyte apoptosis, separation of the dermo-epidermal junction and a neutrophilic inflammatory infiltrate extending from the epidermis to the deep dermis. Scattered neutrophils were also present at the orifice of hair follicles. Histopathologic findings were supportive of the clinical diagnosis of toxic epidermal necrolysis but the neutrophilic component of the inflammatory infiltrate was more consistent with acute generalised exanthematous pustulosis, previously only reported in people. The dog was treated with combination therapy of cyclosporine and equine immunoglobulin and the lesions resolved completely. Aust Vet Practit 2012;42(1):200-205