Case Of the Month

Hepatocutaneous Syndrome

Jasmine Yorkshire Terrier with Hepatocutaneous Syndrome.

Imaged by Andi Parkinsnon, RDMS, Intrapet Imaging, Baltimore Maryland. Intrapet.com.

Jasmine Yorkshire Terrier with Hepatocutaneous Syndrome.

Imaged by Andi Parkinsnon, RDMS, Intrapet Imaging, Baltimore Maryland. Intrapet.com.

History (A. Parkinson RDMS): A 9-year-old FS Yorkshire Terrier was presented for evaluation of a dermatitis characterized by thick crusts involving the pads of all four limbs, as well as the trunk. The crusts were thick and firmly adhered to the underlying dermis. The dog also had hyperkeratoris of the nasal planum, dermatitis of the upper lips and perianal region. The dog was mildly pruritic. The dog was treated with multiple antibiotics, antihistamines and topical, to which there was no response. In addition, the dog had developed progressive anorexia, and weight loss. Skin scrapings and cultures of the skin did not reveal any signs evidence of mites or bacterial growth, respectively. Cytology of the skin scrapings revealed neutrophilic debris, epithelial cells, however, there was no evidence of microorganisms. A CBC was performed and revealed a mild anemia. A serum biochemical profile showed a mild hypoalbuminemia, hypomagnesemia, as well as a mild elevation of the serum alkaline phosphatase enzyme activity, urea and creatinine.

DX

(E Lindquist DMV DABVP): No hepatic biopsy was performed. Dermal and hepatic presentation highly suggestive for clinical diagnosis of hepatocutaneous syndrome.

Outcome

Patient currently under treatment with very guarded long-term prognosis.

Clinical Differential Diagnosis

(L. Carioto DVM, DACVIM Internal Medicine):
1. hepatocutaneous syndrom
2. erythema multiforme
3. pemphigus foleacious
4. Drug eruption

Sonographic Differential Diagnosis

(L Yanik DVM, DACVR): These findings are compatible with an extensive infiltrative process with differentials including neoplasia such as hepatocellular carcinoma, extensive nodular hyperplasia and fibrosis associated with a chronic inflammatory process or possibly hepatocutaneous syndrome. Cirrhosis is considered less likely, given the suspected normal to increased volume of the liver.

Image Interpretation

(L Yanik DVM, DACVR): The included liver is moderately hyperechoic, possessing a complex echotexture comprised of coalescing, isoechoic to hypoechoic, vascular and serosal displacing nodules separated by curvilinear echogenic foci and hyperechoic portal vascular walls.