Case of the Month - Ross Bond - Royal Veterinary College

Case of the Month - Ross Bond - Royal Veterinary College

Seborrhoea and otitis in a crossbred dog Author: Ross Bond Editor: David Lloyd European Society of Veterinary Dermatology History - 1

9-year-old neutered female Collie cross dog Weight 43 kg Has had a dull, somewhat greasy coat for 4 years or more Has always been overweight but gaining more in last 2 years Click to reveal the text on this screen Click the forward arrow to jump to the next screen History | Signs | Differentials | Tests | Therapy | Notes History - 2

Decreased exercise tolerance attributed by owners to weight gain and arthritis (reluctance to exercise) Mild, recurrent head tremor noted on several occasions in the past year Chews and licks feet but not a severe problem, has itchy ears Dog is bright, appetite good, thirst unchanged (1.8-2.0 litres/day) History | Signs | Differentials | Tests | Therapy | Notes

History - 3 Neomycin + betamethasone drops for otitis - little improvement Etiderm (ethyl lactate shampoo) - resolved pedal pruritus but erythema remained. Relapse after 6 weeks Prednoleucotropin (PLT), 1-2 twice daily for arthritis. Some improvement

Efavet 660, 1 twice daily. No effect History | Signs | Differentials | Tests | Therapy | Notes Clinical signs - 1 Bright, alert dog Heart rate 110 beats per minute Rectal temperature 100.5 C Mild generalised seborrhoea Mild erythema and hyperpigmentation of o interdigital skin

Moderate ceruminous otitis History | Signs | Differentials | Tests | Therapy | Notes Clinical signs - 2 The dog was overweight The coat was long, thick and greasy History | Signs | Differentials | Tests | Therapy | Notes

Clinical signs - 3 Anterior and dorsal views of the dog History | Signs | Differentials | Tests | Therapy | Notes How would you approach this case? What are the next steps you would take?

Make a list of your principle differential diagnoses List any samples you would collect List any tests you would perform to assist in making a definitive diagnosis History | Signs | Differentials | Tests | Therapy | Notes Case investigation Principle differential diagnoses Ewan - what would you include? History | Signs | Differentials | Tests | Therapy | Notes

Tests Tests Skin scrapings from feet ..... Ewan where else? Tape strips from interdigital spaces ......? Blood tests Routine haematology Biochemistry panel

History | Signs | Differentials | Tests | Therapy | Notes Results Scrapings did not reveal ectoparasites Tape strips demonstrated substantial numbers of Malassezia in the interdigital spaces Haematological and biochemical profiles were within accepted limits History | Signs | Differentials | Tests | Therapy | Notes

What now? What treatment, if any, should you now institute? What are now your principle differential diagnoses? Are there any other samples you would collect? History | Signs | Differentials | Tests | Therapy | Notes Initial therapy

Ectoparasitism was deemed unlikely Malassezia numbers indicated infection necessitating therapy Owner was instructed to bathe the feet using Malaseb Shampoo twice weekly. Allowing a 10 minute contact time before rinsing. History | Signs | Differentials | Tests | Therapy | Notes What is your diagnosis?

What is your principle diagnosis? Do the investigations permit a definitive diagnosis? Are there any additional investigations which you think may need to be done? History | Signs | Differentials | Tests | Therapy | Notes Further tests

Total T4 and endogenous TSH were measured, Results Total T4 = 12.7 mol/l (13-52) Endogenous TSH = 0.47 g/ l (<0.41) What does this mean? History | Signs | Differentials | Tests | Therapy | Notes

Diagnosis Hypothyroidism diagnosis supported by: Low total T4 and elevated TSH levels Dog overweight

Poor exercise tolerance Susceptibility to skin infection Hypertrichosis History | Signs | Differentials | Tests | Therapy | Notes How would you deal with this case? What is your prognosis? How will you advise the owner?

What treatment would you institute? History | Signs | Differentials | Tests | Therapy | Notes Prognosis Prognosis is good Hypothyroidism normally responds well to therapy with thyroxine Hypothyroidism may explain many, if not all of the

clinical problems in this case History | Signs | Differentials | Tests | Therapy | Notes Therapy Thyroxine administered at 10 ug/kg twice daily for 12 weeks then the 4 hour post-T4 basal plasma total T4 measured and gave a value of 35 nmol/l Maintenance therapy was then established at 15 ug/ kg of thyroxine twice daily

Response. Loss of all hair apart from a short 2-3 cm coat, over a 3 month period History | Signs | Differentials | Tests | Therapy | Notes Response to therapy

Coat then grew gradually to form a normal coat Weight decreased to 32kg over 12 months Exercise tolerance and mobility improved Head tremor absent Coat improved but still some greasiness Continuing mild otitis externa No pruritus History | Signs | Differentials | Tests | Therapy | Notes Points to consider - 1 How do you asses the significance of Malassezia

Could ketoconazole have been used to deal with the Malassezia? Tape strips and surface culture methods only identify superficial populations. Some cases without elevated surface populations will respond to antiyeast therapy Signs were mild and did not justify ketoconazole an unlicensed product. Ketoconazole inhibits steroidogenesis and would have complicated the interpretation of subsequent

endocrine assessments History | Signs | Differentials | Tests | Therapy | Notes Points to consider - 2 Why is hypertrichosis sometimes a feature of hypothyroidism? Thought to be caused by slowed hair cycle turnover telogen hairs not shed and resultant thick coat

It is a common feature of equine hypothyroidism In dogs it is seen particularly in setters History | Signs | Differentials | Tests | Therapy | Notes Review If you would like to review this case, please use the navigation buttons below History | Signs | Differentials | Tests | Therapy | Notes

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