A 3 year old, female intact Great Dane presented for a 2 month history of severe multifocal nodular and ulcerative dermatosis.
Curtis Plowgian, DVM, DACVD
Animal Dermatology Clinic, Indianapolis, IN
History:
Problem began as sores on the muzzle and chin, owner suspected chin acne. Shortly after the onset of sores, eruptions appeared all over the body, and Bella developed a fever (103.5-104.5 F). Lesions also began to appear under the skin and would rupture out into open wounds and fistulae. PDVM treated an antibiotic (cephalexin) which was ineffective, then began injectable Baytril and topical betadine (which were also ineffective). Bacterial culture and sensitivity (MIC) grew a staph and a strep that were both fairly sensitive. Fungal culture was negative. No steroids or other immune-suppressive medications have been started. Blastomyces serum antigen test (Mira Vista) was negative, and CBC/Chemistry was run prior to referral (results unavailable at time of exam).
Exam:
Generalized nodular fistulous dermatosis was noted over the entire body, including fissures and ulcers in the nares, on the nasal planum, and on the tongue and gingiva (see images below). There was also erythema, crusting, and brown exudate present in both ear canals.
Diagnostics:
Ear swab: 10-20 yeast and cocci per OIF (oil immersion field) AU
Cytology (draining tracts): TNTC white blood cells, with occasional cocci, and clusters of multiple thick-walled, intensely basophilic yeasts with broad based budding (see images below)
Assessment:
Generalized (disseminated) blastomycosis
Secondary staph pyoderma and mixed otitis externa AU
Treatment:
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- Miller W, Griffin C, Campbell K. Muller and Kirk’s Small Animal Dermatology, p 259-261.
- Arceneaux KA1,Taboada J, Hosgood G. Blastomycosis in dogs: 115 cases (1980-1995). JAVMA 01 Sep 1998, 213(5):658-664 PMID: 9731260
- Spector, A.M. Legendre, et al. Antigen and Antibody Testing for the Diagnosis of Blastomycosis in Dogs. JVIM, Volume22, Issue 4, July–August 2008, p 839-843.
- Werner A, Norton F. Blastomycosis. Compendium, August 2011, E1-E5.
- Alfred M. Legendre DVM, et al. Treatment of Blastomycosis With Itraconazole in 112 Dogs. JVIM, Volume10, Issue 6, November 1996, p 365-371.
CORRECTION: This post previously stated that the Blastomyces antigen test through Mira Vista was urine (not serum). This post has been updated to correct this error.