Ramos Sara J, Beale Victoria M, Langohr Ingeborg M, Woodward Michelle C
From the Department of Veterinary Clinical Sciences (S.J.R., V.M.B., M.C.W.), and Department of Pathobiological Sciences (I.M.L.), School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana.
J Am Anim Hosp Assoc. 2020 Mar/Apr;56(2):133-138. doi: 10.5326/JAAHA-MS-6896. Epub 2020 Jan 21.
An ∼12 yr old castrated mixed-breed dog was evaluated for a 7 wk progressive history of intermittent hyporexia, lethargy, and erosive dermatitis. Initial examination revealed disseminated papules and macules coalescing to irregularly shaped and serpiginous plaques with widespread erosion progressing to ulceration. Skin histopathology revealed transepidermal keratinocyte apoptosis with lymphocyte satellitosis and lymphocytic and histiocytic interface infiltrate. Histopathology combined with clinical signs and history were compatible with the diagnosis of erythema multiforme major. Treatment was initiated with multidrug immunosuppression. Following 36 hr with no improvement, intravenous human immunoglobulin (0.45 mg/kg IV) was administered resulting in notable improvement in the dog's attitude and appetite within 2 hr and the dog's skin lesions within 48 hr. Following discharge, the dog improved daily with near complete resolution of dermatologic disease achieved 1 mo postdischarge. All immunosuppressive medications were ultimately discontinued 5 mo following presentation. This is the first report of a dog with erythema multiforme major that has been successfully treated with a combination of intravenous immunoglobulin and immunosuppression.
一只约12岁的去势混血犬因间歇性食欲减退、嗜睡和糜烂性皮炎的7周渐进性病史而接受评估。初步检查发现散在的丘疹和斑疹融合成不规则形状和匐行性斑块，伴有广泛糜烂并进展为溃疡。皮肤组织病理学显示表皮角质形成细胞凋亡，伴有淋巴细胞卫星现象以及淋巴细胞和组织细胞界面浸润。组织病理学结合临床症状和病史与重症多形红斑的诊断相符。开始采用多药免疫抑制治疗。36小时后无改善，给予静脉注射人免疫球蛋白（0.45mg/kg静脉注射），2小时内犬的精神状态和食欲有明显改善，48小时内犬的皮肤病变有所改善。出院后，犬的情况每日好转，出院1个月后皮肤病基本完全消退。就诊5个月后最终停用所有免疫抑制药物。这是首例成功使用静脉注射免疫球蛋白和免疫抑制联合治疗重症多形红斑犬的报告。
