Cutaneous Manifestations of Systemic Disease (NAVDF 2021 Outerbridge) Flashcards by Elana Vlodaver

Name 6 paraneoplastic skin lesions

1) Feline paraneoplastic alopecia
2) Feline thymoma-assocaited exfoliative dermatitis
3) Canine nodular dermatofibrosis
4) Canine paraneoplastic pemphigus
5) Canine superficial necrolytic dermatitis/metabolic epidermal necrosis (small % have glucagonoma trigger)
6) Canine Sertoli cells/ testicular neoplasia

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What cancer is associated with feline paraneoplastic alopecia

Pancreatic adenocarcinoma +/- metastasis

Shiny skin, ventral alopecia

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Clinical signs of feline paraneoplastic alopecia

Shiny skin, ventral alopecia
Hair epilates easily
Rapid onset
Dry, fissured, peeling pawpads

Increased grooming and SECONDARY Malassezia dermatitis

Often feel systemically unwell

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Histopath of feline paraneoplastic alopecia

Follicular atrophy w/ miniaturization
Epidermal hyperplasia (opposite of what you’d see with hormonal!)

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Prognosis of feline paraneoplastic aloepcia

Hair may grow back, but there is metastasis is already there. So cats will ultimately die from their cancer

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Lethal acrodermatitis breed

White bull terriers

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Lethal acrodermatitis mode of inheritance

Autosomal recessive

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Cause of Lethal acrodermatitis

MKLN1
Defect in Zinc absorption/metabolism (?)

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Lethal acrodermatitis copper and zinc levels

LOW

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Lethal acrodermatitis IgA levels

LOW

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How can you tell if a puppy has Lethal acrodermatitis

Stunted growth
Arched hard palate – food gets stuck in high in hard palate!
Crusted distal extremities, paws

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Histopath Lethal acrodermatitis

Severe parakeratosis

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Lethal acrodermatitis prognosis

Die <1 year old; fatal bronchopneumonia

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Feline thymoma-associated exfoliative dermatitis: where on the body does it start

Head/neck, then generalizes

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Clinical signs of Feline thymoma-associated exfoliative dermatitis

Erythema with dramati exfoliation

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Histopath of Feline thymoma-associated exfoliative dermatitis

CD3+ interface dermatitis and mural folliculitis

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Prognosis of Feline thymoma-associated exfoliative dermatitis

Good. If you remove the tumor, the cutaneous signs resolve.

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NON-thymoma-associated exfoliative dermatitis in cats: treatment

Immunosuppressive glucocorticoids or cyclosporine

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Renal Cystadenocarcinoma and Nodular Dermatofibrosis breed

GSD

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Renal Cystadenocarcinoma and Nodular Dermatofibrosis Gene, mode of inheritance

FLCN, Autosomal dominant

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T or F: if you note a cystadenocarcinoma on ONE kidney of a dog with Renal Cystadenocarcinoma and Nodular Dermatofibrosis, should you perform a nephrectomy

No, its likely to develop lesions on the other kidney

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Other than the kidneys/skin, what other organ can be affected by Renal Cystadenocarcinoma and Nodular Dermatofibrosis

Uterine myoleioma in female intact dogs

Histopath of Nodular Dermatofibrosis

Dense, mature collagen

What type of cancer metastasizes to the digits in cats

Primary pulmonary carcinoma

Treatment for feline herpesviral deramtitis in cats

1) human alpha-interferon SC 3x/w 2) Famciclovir q8h 3) Lysine 4) Tx 2' infections

What is doperidone? Which disease can it be helpful for

Doperidone = dopamine D2 receptor antagonist. Give it CONCURRENTLY with insect repellent to help PREVENT sand flies --> Leishmania

Canine distemper virus organ systems

GI, CNS, Skin

What other species can contract canine distemper virus

Raccoons, ferrets

How much of the body's total zinc is stored in the skin?

20% Mostly in nasal planum, tongue, paw pads

Signalment of dog with Syndrome I Zinc Responsive Dermatosis

Arctic breeds (husky, Malamute) Suspect GI absorption issue. Tx with Zn supplementation 1-3mg zn/d

Signalment of dog with Syndrome II Zinc Responsive Dermatosis

Puppy on poor diet-- either too low in Zinc or too high in minerals (Ca2+, Fe) or phytates --> chelate zinc so not available

Which food is high in phytates, and can lead to Syndrome II Zinc Responsive Dermatosis

Cereal grains

Which zinc salt is most effective at treating Zinc Responsive Dermatosis

All have similar efficacy! It just depends on the dog individually Resolves in 4-6 weeks with appropriate treatment

What is a more common clinical finding for hepatocutaneous syndrome: metabolic/vacuolar hepatopathy or glucagonoma?

Metabolic, vacuolar hepatopathy in >95% of cases

Pathoetiology of glucagonoma causing hepatocutaneous syndrome

Glucagon tells liver to turn amino acids to glucose (gluconeogenes) --> results in mobilization of amino acids --> amino acid deficiency Additionally hyperglycemia, increased insulin resistance, and diabetes mellitus in about 1/3 of cases

T or F: about 1/3 of hepatocutaneous syndrome dogs have diabetes mellitus

True. Monitor for it while treating too

What finding is present in all cases of hepatocutaneous syndrome

Hypoaminoacidemia (also lysine uria)

Which medication has been associated with hepatocutaneous syndrome

Phenobarbital

Signalment predisposed to hepatocutaneous syndrome

Small breed, male dogs Sheltie, Cocker spaniel, Terriers (jack russel, scottish, WHWT)

Which breed has a possible familial hepatocutaneous syndrome

Shih tzus!

Treatment for hepatocutaneous syndrome

Amino acid nutrition is KEY -IV AA (avoid in dogs with pre-existing renal, liver dz) -High protein, easily digestible diet *supplement Zn, essential fatty acids (carried by albumin, so end up deficient in these)

What liver finding is classic on abdominal ultrasound for hepatocutaneous syndrome

Honeycomb liver (NOT fibrosis)

Would you find a honeycomb liver on AUS of a dog with glucogonoma-derived hepatocutaneous syndrome

NO. But you would see a pancreatic mass (or metastatic liver nodules) HONEY COMB LIVER IS ABSENT IN GLUCAGONOMA HCS

What labwork findings would you expect with hepatocutaneous syndrome

Increased ALP (98%) Increased ALT (71%) +/- anemia, hypoalbuminemia, diabetes mellitus (~1/3)

What amino acid is present in the urine of dogs with hepatocutaneous syndrome

Lysine (100%) (Proline in some cases)

Systemic diseases you should look for in vasculitis cases

*Tick titers *Leishmania *Bartonella titers *FIP

Cause of cutaneous xanthoma in cats

Dislipoproteinemia

Clinical signs of cutaneous xanthoma

Pale yellow/white plaques, nodules with erythematous borders On boney prominences, face, limbs, trunk

Next step after diagnosing cutaneous xanthoma

Identify underlying lipid metabolism dysfunction r/o diabetes mellitus, hereditary dislipoproteinemia

Treatment for cutaneous xanthoma

Low fat diet (Stop the macrophages from being filled with lipid!)

Diagnosis criteria for SLE

2+ organ systems involved Fever +/- positive ANA

Common clinical signs of SLE

Fever Protein losing nephropathy Polyarthritis Thrombocytopenia Anemia <20% have skin lesions!

T or F: sterile nodular panniculitis can be associated with pancreatitis or immune-mediated diseases

True. Can also be idiopathic (more common)! 83% have no concurrent diseases

Breeds predisposed to sterile nodular panniculitis

Aussie Brittany spaniel Dalmatian Pomeranian Chihuahua