1. Generalised scaling in a male donkey Author: Mark CraigEditor: David Lloyd © European Society of Veterinary Dermatology

2. History | Signs | Differentials | Tests | Therapy | Notes Click to reveal the text on this screen Click the forward arrow to jump to the next screen History 10-year-old entire male donkey First signs Reduced appetite, weight loss, generalised scaling In progress over a 3-month period Treatment by referring vet Intramuscular penicillin/streptomycin daily for 10 days No improvement

3. History | Signs | Differentials | Tests | Therapy | Notes Clinical signs - 1 Signs Generalised exfoliative erythroderma Thin, depressed Rectal temperature, pulse rate, respiratory rate normal No peripheral lymphadenopathy No oral lesions were present

4. History | Signs | Differentials | Tests | Therapy | Notes Clinical signs - 2 Signs The donkey is thin and depressed There is poor coat with generalised scaling

5. History | Signs | Differentials | Tests | Therapy | Notes Clinical signs - 3 Signs Periocular scaling and greasy matted hair around the eye Exfoliation and erythema of the scrotum

6. History | Signs | Differentials | Tests | Therapy | Notes Clinical signs - 4 Signs Close up of scaling, matting of coat and underlying erythema

7. History | Signs | Differentials | Tests | Therapy | Notes How would you approach this case? Signs 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

8. History | Signs | Differentials | Tests | Therapy | Notes Differential diagnoses Differentials Bacterial infection including dermatophilosis Dermatophytosis Pemphigus foliaceus, SLE Drug eruption Cutaneous lymphoma

9. History | Signs | Differentials | Tests | Therapy | Notes Tests - 1 Tests Skin scrapings Blood tests: routine haematological and biochemical screens Fungal culture of scale and hairs Multiple skin biopsy samples

10. History | Signs | Differentials | Tests | Therapy | Notes Tests - 2 Tests Scrapings did not reveal ectoparasites or fungal structures Scales/crusts were emulsified and smears examined for bacteria including Dermatophilus; no significant findings Haematology: marked leukocytosis (35.1 x 10 3 /mm 3 ) with neutrophilia and lymphocytosis, slightly reduced RBC count. Blood biochemistry: raised total protein, hyperglobulinaemia, raised ALP and CK

11. History | Signs | Differentials | Tests | Therapy | Notes What now? Tests What treatment should you now institute, if any, whilst waiting for the fungal cultures and biopsy results? What are now your principle differential diagnoses? Are there any other samples you would collect?

12. History | Signs | Differentials | Tests | Therapy | Notes Tests - 3 Tests No immediate action taken No parasites or evidence of dermatophytes demonstrated in scrapings Smears failed to reveal significant bacteria The leucocytosis (neutrophilia + lymphocytosis) were suggestive of possible bacterial infection but the blood biochemistry results were not diagnostic Antibacterial therapy might have been instituted but was inhibited by cost and because no significant deterioration was expected before biopsy results were available

13. History | Signs | Differentials | Tests | Therapy | Notes Results Tests An interface dermatitis pattern predominated, possible indicating lupus or a drug eruption Histopathology

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

15. History | Signs | Differentials | Tests | Therapy | Notes Further steps Tests Consultation with the pathologist The histological picture was not clear and the pathologist suggested a second opinion supported by immunohistochemical studies

16. History | Signs | Differentials | Tests | Therapy | Notes Results Tests Another view of the histopathology showing lichenoid infiltration and microabscess formation with predominantly mononuclear cells Histopathology

17. History | Signs | Differentials | Tests | Therapy | Notes Diagnosis Tests Subsequent immunohistochemical studies showed a strong reaction to CD-3 of infiltrating cells. A diagnosis of epidermotropic lymphoma was made

18. History | Signs | Differentials | Tests | Therapy | Notes How would you deal with this case? Therapy What is your prognosis? How will you advise the owner? What treatment would you consider?

19. History | Signs | Differentials | Tests | Therapy | Notes Prognosis Therapy Prognosis is grave Disease is fatal Steroids and cytotoxic drugs are unlikely to be helpful Euthanasia was carried out

20. History | Signs | Differentials | Tests | Therapy | Notes Review Notes If you would like to review this case, please use the navigation buttons below