mycophenolic-acid and Dermatitis

Sterile neutrophilic dermatosis is a rare disease in dogs, similar to Sweet's syndrome in humans. This case report describes the treatment of a 2-year old Bearded Collie that was presented with a 3-week history of fever, hind-limb weakness, peripheral lymphadenomegaly and leucocytosis. Blood tests revealed severe leukocytosis, renal azotaemia, elevated liver enzymes and bilirubinaemia. Skin lesions started to appear in week four. Histology revealed a sterile neutrophilic dermatitis resembling Sweet's syndrome. The dog displayed extracutaneous manifestations, including fever, polyarthritis, a severe leukemoid reaction, anaemia, hepatopathy and nephropathy. Issues regarding the use of criteria for the diagnosis of Sweet's syndrome in humans that are used for dogs with sterile neutrophilic dermatosis, are discussed in this case report. The condition resolved with dexamethasone and mycophenolate mofetil as a novel steroid-sparing therapy. Three months later the dog relapsed, which rapidly responded to short-term dexamethasone treatment and temporarily increased mycophenolate mofetil dosage.. Sterile neutrophile Dermatose ist eine seltene Erkrankung bei Hunden, vergleichbar dem Sweet'schen Syndrom beim Mensch. Dieser Fallbericht beschreibt die Behandlung eines zweijährigen Bearded Collie mit einer 3-wöchigen Vorgeschichte von Fieber, Schwäche der hinteren Gliedmaßen und peripherer Lymphadenomegalie und Leukozytose. Die Laborwerte wiesen eine schwere Leukozytose, renale Azotaämie, erhöhte Leberenzyme und Bilirubinämie auf. Hautveränderungen zeigten sich ab der vierten Woche. Die Histologie ergab eine sterile neutrophile Dermatitis, die dem Sweet’schen Syndrom ähnelt. Zusätzlich wurden extrakutane Manifestationen festgestellt, einschließlich Fieber, Poly­arthritis, eine schwere Leukozytose, Anämie, Hepatopathie und Nephropathie. Der vorliegende Fallbericht diskutiert Fragen inwieweit Kriterien für die Diagnose des Sweet-Syndroms beim Menschen bei Hunden mit steriler neutrophiler Derma­tose verwendet werden können. Eine steroidschonende Therapie mittels Dexamethason und Mycophenolat-Mofetil führte zu einer Abheilung. Drei Monate später erlitt der Hund einen Rückfall, der rasch und kurzfristig auf die Behandlung mit Dexamethason und einer erhöhten Mycophenolat-Mofetil-Dosierung reagierte.. La dermatose neutrophilique stérile est une maladie rare chez le chien, semblable au syndrome de Sweet chez l’homme. Ce rapport de cas décrit le traitement d’un Bearded Collie de 2 ans présentant des antécédents de fièvre pendant 3 semaines, une faiblesse des membres postérieurs, une lymphadénomégalie périphérique et une leucocytose. Les analyses de sang ont révélé une leucocytose grave, une azotémie rénale, une élévation des enzymes hépatiques et une bilirubinémie. Des lésions cutanées ont commencé à apparaître à la quatrième semaine. L’histologie a révélé une dermatite neutrophilique stérile ressemblant au syndrome de Sweet. Le chien présentait des manifestations extracutanées telles que fièvre, polyarthrite, réaction leucémoïde sévère, anémie, hépatopathie et néphropathie. Les questions relatives à l’utilisation des critères de diagnostic du syndrome de Sweet chez l’homme chez les chiens atteints de dermatose neutrophilique stérile sont abordées dans le présent rapport de cas. La maladie a été traitée avec la dexaméthasone et le mycophénolate mofétil en tant que thérapie innovante permettant d’économiser des stéroïdes. Trois mois plus tard, le chien a rechuté mais a rapidement répondu à un traitement de courte durée à la dexaméthasone et à une augmentation temporairement la dose de mycophénolate mofétil.. La dermatosi neutrofila sterile è una malattia rara nei cani ed è simile alla sindrome di Sweet negli esseri umani. Questo studio descrive il trattamento di un bearded collie di 2 anni che è stato presentato con una storia di febbre di 3 settimane, debolezza degli arti posteriori, linfoadenomegalia periferica e leucocitosi. Gli esami del sangue hanno rivelato grave leucocitosi, azotemia renale, enzimi epatici elevati e bilirubinemia. Le lesioni cutanee sono apparse alla quarta settimana. L’istologia ha rivelato una dermatosi neutrofila sterile simile alla sindrome di Sweet. Il cane mostrava delle manifestazioni extracutanee, compresa febbre, poliartrite, una reazione leucemoide severa, anemia, epatopatia e nefropatia. In questo studio viene discussa la questione dell’uso dei criteri per la diagnosi della sindrome di Sweet negli esseri umani che vengono utilizzati per i cani affetti da dermatosi neutrofila sterile. La patologia si è risolta con l’assunzione di desametasone e micofenolato mofetile come nuova terapia a effetto di risparmio di steroidi. Tre mesi dopo il cane ha avuto una ricaduta. Il cane ha reagito rapidamente al trattamento a breve termine con desametasone e un dosaggio aumentato temporaneamente di micofenolato mofetile.

Topics: Animals; Anti-Inflammatory Agents; Antibiotics, Antineoplastic; Dermatitis; Dexamethasone; Dog Diseases; Dogs; Mycophenolic Acid; Treatment Outcome

Papular dermatitis is an intensely pruritic eruption that is often refractory to conventional therapy.. The aim of this study was to evaluate the efficacy of different non-steroidal systemic therapies for long-term control of disease in patients with papular dermatitis.. This was a single center, retrospective study involving a chart review of patients with a diagnosis of papular dermatitis who were prescribed systemic therapy between 1 January 2002 and 31 December 2012.. Fourteen patients were identified that were treated with a systemic agent. Median duration of treatment was 25 months. Methotrexate was used first line in 12 patients, with control of disease achieved in eight patients with a dose between 2.5 and 10 mg weekly. Azathioprine and mycophenolate mofetil also provided control of disease when used as first-line therapy in the remaining two patients. While azathiopurine was effective in patients who failed methotrexate, gastrointestinal side effects limited its use long term.. Low dose weekly methotrexate, as well as, azathioprine and mycophenolate mofetil are long-term treatment options for patients with papular dermatitis refractory to other therapies.

Topics: Adrenal Cortex Hormones; Adult; Aged; Azathioprine; Dermatitis; Drug Administration Schedule; Female; Humans; Male; Methotrexate; Middle Aged; Mycophenolic Acid; Retrospective Studies; Treatment Outcome

Topics: Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Delayed Diagnosis; Dermatitis; Diagnostic Errors; Drug Substitution; Humans; Immunocompromised Host; Immunosuppressive Agents; Kidney Transplantation; Mycophenolic Acid; Postoperative Complications; Postoperative Period; Prednisone; Sarcoma, Kaposi; Sirolimus; Skin Neoplasms; Tacrolimus; Vinblastine

A 7-year-old female Cocker spaniel-cross was referred with an 8-month history of mucocutaneous erosive dermatitis. On physical examination, skin lesions affected the eyelids and periocular area, lips and vulva. Lesions were symmetrical with small diffuse superficial ulcers, haemorrhagic crusts, adherent purulent exudation in haired skin, and alopecia with hyperpigmentation and scarring. Histopathologic evaluation showed multiple, non-intact dermoepidermal junction vesicles and ulceration associated with a dermal lichenoid infiltrate. Immunohistochemistry showed strong to moderate reactivity in the dermoepidermal junction for the antibodies directed against canine IgG, human IgG lambda light chains and C3, respectively. A diagnosis of autoimmune subepidermal blistering dermatosis was made. Treatment with oral prednisone at 2 mg/kg and mycophenolate mofetil (MMF) at 20 mg/kg twice daily was initiated and after 4 weeks the ulcers and erosions were cured. During the rest of treatment, MMF was maintained at 10 mg/kg twice daily and prednisone could be tapered to 0.25 mg/kg once every other day without recurrences. In conclusion, this case report shows that MMF was well tolerated and might be effective as steroid-sparing agent in the long-term treatment of this autoimmune subepidermal blistering disease.

Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Autoimmune Diseases; Dermatitis; Dog Diseases; Dogs; Female; Mycophenolic Acid; Prednisone

Topics: Administration, Cutaneous; Adult; Aged; Back; Dermatitis; Dermatologic Agents; Diagnosis, Differential; Female; Humans; IMP Dehydrogenase; Male; Middle Aged; Mycophenolic Acid; Prodrugs

Topics: Adult; Arthritis; Blind Loop Syndrome; Colonic Pouches; Dermatitis; Female; Humans; Immunosuppressive Agents; Mycophenolic Acid