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EV ACVD Study > Erythema Multiforme, SJS, TEN > Flashcards

Erythema Multiforme, SJS, TEN Flashcards

1
Q

Hyperkeratotic Erythema multiforme: sex

A

Males > females

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2
Q

Erythema multiforme: breed

A

German Shepherd
Pembroke Welsh Corgi

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3
Q

Erythema multiforme: age

A

Any

Hyperkeratotic form = old dogs!

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4
Q

Erythema multiforme: most common trigger in HUMANs

A

Herpes virus

Drugs <10%

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5
Q

Erythema multiforme: pathogenesis (humans)

A

LC bind antigen –> LC show antigen to keratinocytes –> Keratinocytes express an antigen (drug, infectious agent antigen)–> lymphocytes respond to antigen-bound keratinocyte

*Dermis: CD4+ (Th1) –> IFNg (virus) or TNFa (drugs)

*Epidermis: CD8+, NK cells –> granulysin release –> Apoptosis

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6
Q

Which cytokine is important for EM, by upregulating MHC cl I and clI, enabling keratinocytes to present MORE antigens?

A

IFNg

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7
Q

Which cytokine is important for EM, by:
1) Chemoattractant for NK cells
2) upregulating adhesion molecules (ICAM1 in epidermis)

A

IFNg

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8
Q

Which MHC is upregulated in EM keratinocytes in dogs?

A

*MHC class II

*Overexpress CD44 (attracts leukocytes)
*Overexpress ICAM1 (binding of leukocytes)

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9
Q

Which APCs over abundant in the epidermis in EM?

A

*LCs, DCs
*CD8+>CD4+ T cells
*NK cells

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10
Q

Which type of T cell is abundant in EM skin

A

CD8 (in BOTH epidermis and dermis)

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11
Q

Triggers for Erythema multiforme in Dogs

A

*Infections (CHV, CPV-2, distemper, Staphylococcus/dermatitis, Pseudomonas/otitis, E coli/ OM, anal sacculitis, Pneumocystis

*Drugs (19-59%) (antimicrobials, antiepileptics/zonisamide, nutraceuticals)

*CAFR
*Neoplasia (thymoma, leukemia)
*Burn
*Idiopathic (23-43%): Hyperkeratotic EM

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12
Q

Triggers for Erythema multiforme in cats

A

*Infections: FHV
*Drugs (up to 100%): usually antimicrobials
*Neoplasia (thymoma)
*Idiopathic

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13
Q

Triggers for Erythema multiforme in other species

A

*Herpesvirus: horse, pig
*Distemper virus: ferret
*Antimicrobials: horse
*Food: horse
*Neoplasia: lymphoma, horse
*Idiopathic

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14
Q

Difference between EM minor and EM major

A

Minor: No systemic signs, 0-1 mucosae affected

Major: >1 mucosae affected + systemic signs

Both have <50% body surface affected (otherwise, SJS or TEN)

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15
Q

Histopath differences between EM, SJS-TEN, LE, thymoma-associated exfoliative dermatitis (cats)

A

*SJS/TEN have less apoptosis and more necrosis. Less inflammation
HOWEVER, its a CLINICAL diagnosis, as so similar on histopath

*LE: Apoptosis is only in basal layer, not multilayer (like EM)

*Thymoma: less apoptosis

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16
Q

Difference between hyperaesthetic leukotrichia and EM in horses

A

*EM has MORE lymphocytic exocytosis, satellitosis
*Hyperaesthetic leukotrichia has more pigmentary incontinence, more edema in superficial dermis

Also hyperaesthetic leukotrichia is painful at the start, EM is usually not initially

17
Q

EM best treatment option

A

Glucocorticoid + cyclosporine combo

(Oclacitinib in hyperkeratotic EM form!)

18
Q

Why does oclacitinib work for hyperkeratotic EM?

A

Blocks IFNg, which is important for EM in humans

19
Q

SJS/TEN triggers in human

A

USUALLY DRUGS (vs EM is herpes)

*Sulfonamides
*NSAIDs
*Antiepileptics
*Allopurinol
-Do NOT need prior sensitization. Can occur the 1st time someone gets a drug

*Infections (3%), neoplasia, Idiopathic (7-30%)

20
Q

Which molecules are risk factors for SJS/TEN in humans?

A

MHC class I molecules

Interact with certain drugs inappropriately

Interact with drug metabolite-specific CD8 T cells, NK cells -> cytokines (TNFa), granulysin, Fas, FasL, perforin, granzyme –> Apoptosis, full thickness necrosis

21
Q

Which Cytokine is the most important in SJS/TEN

A

TNFa

22
Q

Which cytokine upregulates MHC class I and FasL on keratinocytes in SJS/TEN

A

TNFa

23
Q

Trigger for SJS/TEN in dogs

A

DRUGS (92%)
*Antimicrobials (cephalosporins, TMS, amoxicillin)
*NSAIDs, carprofen
*Phenobarbital
*Cannabidiol
*Griseofulvin
*Flea meds, ivermectin, moxidectin, anesthesia, others
Skin lesions develop 1-3 weeks after getting drugs

Infections (bacterial)
Neoplasia (splenic sarcoma)
Idiopathic

24
Q

Which drug is MOST likely to trigger SJS/TEN in dogs

A

Amoxicillin

> carprofen, phenobarbital

25
Q

Which drug is MOST likely to trigger SJS/TEN in cats

A

Cefadroxil
»
Griseofulvin
Flea dip
Vaccine

26
Q

Which drug is MOST likely to trigger SJS/TEN in horses

A

Sulfonamides

27
Q

Which drug is MOST likely to trigger SJS/TEN in cows

A

Mycoplasma bovis

28
Q

Difference between SJS, TEN

A

SJS: <10% body surface area is detached

TEN: >30% body surface area detached

Middle ground: 10-30%

In BOTH: systemic sighns, >1 mucosa involved, >50% BSA is erythema/purpura

29
Q

Differences between EM minor, EM major, SJS, TEN

A

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