Canine Acute Eosinophilic Dermatitis with Edema (Well's Syndrome) Flashcards
When do GI signs appear with CAEDE?
Prior to skin lesions or concurrently
Describe GI signs with CAEDE
Moderate to severe including significant vomiting, diarrhea, hematemesis and/or hematochezia, hypoproteinemia, may require hospitalization
Describe skin lesions with CAEDE
- bright red macules
- generalized erythema most evident on glabrous skin of abdomen
- erythematous arciform to serpiginous macules and plaques with edema
- Targeted (bull’s eye) lesions that may mimic erythema multiforme or vasculitis
- pitting edema or facial edema that resembles urticaria
- typically no vascular compromise (cutaneous necrosis or ischemia) as seen with vasculitis
- do not typically have flexural fold or distal extremity lesions (erythema, hyperpigmentation, and lichenification) of CAD
- not usually pruritic
Name differentials for CAEDE
Vasculitis, erythema multiforme, Sweet’s syndrome, sterile pustular erythroderma of schnauzers
What is the etiology of CAEDE?
Unknown, adverse drug reaction or unknown systemic hypersensitivity may play a role (systemic type I hypersensitivity)
What are the histologic features of CAEDE?
- robust eosinophilic infiltrate with edema
- collagen flame figures (foci of densely eosinophilic protein deposits on dermal collagen)
- ecstatic blood vessels
Name 3 patterns of severity of histologic lesions with CAEDA.
What is the significance of the patterns?
- very mild eosinophilic with or without neutrophilic inflammation in the superficial dermis with vascular ectasia
- more extensive inflammation that extend into deeper dermis with few collagen flame figures
- most severe and diffuse inflammation
Histologic lesions represent progression of skin lesions but do not predict patient outcome or trigger.
Name 3 patterns of severity of histologic lesions with CAEDA.
What is the significance of the patterns?
- very mild eosinophilic
What is the difference between Well’s Syndrome in people and CAEDE in dogs?
Well’s tends to be a more focal lesion on an extremity
Name the factors most common with CAEDE
- significant vomiting and diarrhea, may require hospitalization
- hypoproteinemia
- treatment with multiple medications
- acute onset erythroderma and edema in a ventrally oriented distribution
Name the factors most common with CAEDE
- significant vomiting and diarrhea, may require hospitalization
- hypoproteinemia
- treatment with multiple medications
- acute onset erythroderma and edema in a ventrally oriented distribution
What is the treatment for CAEDE?
- withdraw drugs administered prior to onset
- Corticosteroids and antihistamines
- GI typically resolves in a week, skin lesions about 3 weeks
- one case of recurrent skin lesions without GI signs
Why is distinguishing between CAEDE and Sweet’s difficult?
- eosinophils in tissue may undergo degranulation making it difficult to distinguish from neutrophils
- eosinophils have been reported as a component of the inflammatory infiltrate in CSS
- some cases in older literature of diagnosis as CSS might now be classified as CAEDE
(sterile pustular erythroderma of schnauzers histologically identical to CAEDE or CSS depending on predominant dermal inflammatory infiltrate, eosinophils or neutrophils)
What stain can be used to assess for the granules in eosinophils?
Luna histochemical stain
What are the clinical signs of Canine Sterile Neutrophilic Dermatosis (Canine Sweet’s Syndrome/CSS)?
- systemic illness (fever, neutrophilic, arthritis, pneumonia)
- similar skin lesions to CAEDE but possibly more pustular and also most apparent on glabrous skin
- dermis contains a marked neutrophilic infiltrate with or without eosinophils
- some putatively associated with adverse drug reactions
