A 9-year-old FS mixed-breed dog presented for crusting skin lesions on the foot pads and perineal region. Physical examination was otherwise normal. Radiographs were normal except for mild uniform hepatomegaly. CBC demonstrated mild regenerative anemia, and the blood chemistry revealed only a mildly elevated SAP. Moderately positive ACTH stimulation for pituitary-dependent hyperadrenocorticism (PDH).
A 9-year-old FS mixed-breed dog presented for crusting skin lesions on the foot pads and perineal region. Physical examination was otherwise normal. Radiographs were normal except for mild uniform hepatomegaly. CBC demonstrated mild regenerative anemia, and the blood chemistry revealed only a mildly elevated SAP. Moderately positive ACTH stimulation for pituitary-dependent hyperadrenocorticism (PDH).
Case Study
Hepatocutaneous syndrome with crusting skin lesions in a 9 year old FS mixed breed dog
DX
Sonographic Differential Diagnosis
Moderately to markedly heterogeneous liver with a portal vasculature. Given the history, primary consideration is given to developing hepatocutaneous syndrome or superficial necrolytic dermatitis. Hepatic neoplasia with an associated paraneoplastic syndrome and an unrelated chronic inflammatory hepatopathy cannot be ruled out definitively.
Image Interpretation
The hepatic parenchyma is diffusely hypoechoic with a moderately to markedly heteroechoic nodular pattern. The intrahepatic portal vascular walls are also diffusely thickened and echogenic. The hepatic volume is within normal limits. The gallbladder is normally filled with anechoic fluid and shows no evidence of wall thickening.
Outcome
Amino acid infusion therapy with neutraceutical support was able to achieve 90 percent resolution of the crusting skin lesions on the thorax, muzzle, and flank with 40 percent resolution of the foot pad lesions. The patient was clinically comfortable at a 3-month follow-up with conserved appetite and energy. The patient’s clinical status declined at 3 months post-diagnosis, and the animal was euthanized humanely.
Comments
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Clinical Differential Diagnosis
Skin pathology: dermatitis of infectious or immune-mediated origin, superficial necrolytic dermatitis (hepatocutaneous syndrome); Liver pathology: steroid hepatopathy, neoplasia.
Sampling
16-gauge US-guided liver biopsies revealed mild hepatocellular vacuolization with multifocal nodular hyperplasia and multifocal lipochrome-laden macrophages, lymphocytes, and plasma cells. Concurrent skin lesion biopsies demonstrated diffuse, moderate, irregular epidermal acanthosis with regionally extensive parakeratosis and mid-epidermal edema and spongiosis. Diffuse, superficial, moderate lymphoplasmacytic dermatitis with melanosis also was present. Hepatocutaneous syndrome.
Patient Information
Clinical Signs
- Skin Lesion
Exam Finding
- Hepatomegaly
Images
Blood Chemistry
- Alkaline Phosphatase (SAP), High
CBC
- RBC, Low
Clinical Signs
- Skin Lesion
Special Testing
- ACTH Stim Positive for Cushing's