Combarros Daniel, Moulin Jean-Paul, Correge Sophie, Delverdier Maxence, Cadiergues Marie-Christine
Department of Clinical Sciences, Université de Toulouse, ENVT, Toulouse, France; UDEAR, Université de Toulouse, INSERM, ENVT, Toulouse, France.
Veterinary Clinic, Saint-Céré, France.
JFMS Open Rep. 2020 Feb 11;6(1):2055116920902307. doi: 10.1177/2055116920902307. eCollection 2020 Jan-Jun.
A 6-year-old neutered female European Shorthair cat was referred for chronic, moderately pruritic, alopecic and exfoliative dermatosis that was unresponsive to antiparasitic, antibiotic or steroidal anti-inflammatory drugs. The cat presented with truncular alopecia and numerous whitish adherent scales covering the whole body. Differential diagnoses included sebaceous adenitis, dermatophytosis, demodicosis, exfoliative dermatitis associated or not with thymoma, drug reaction, feline immunodeficiency virus- or feline leukaemia virus-associated dermatoses, epitheliotropic T-cell lymphoma, and yeasts and/or bacterial overgrowth. Blood tests were within normal limits and the retrovirus tests were negative. Skin scrapings, fungal culture, coat brushing and skin cytology were negative for parasitic or microbial elements. Radiographs showed no signs of a thymic mass. Histological examination of skin biopsies revealed marked orthokeratotic hyperkeratosis, lymphocytic (CD3) interface dermatitis and mural folliculitis with absence of sebaceous glands and occasional apoptotic cells in different epidermal layers. Clinical and histological findings were consistent with non-thymoma-associated exfoliative dermatitis syndrome. Ciclosporin A (7 mg/kg) was administered once daily. A dramatic improvement was observed after 3 weeks. Ciclosporin A intake was then progressively spaced out as the clinical signs diminished. Skin biopsies revealed resolution of hyperkeratosis, disappearance of the inflammatory infiltrate and recovery of the sebaceous glands.
T-cell infiltration with signs of epidermal cytotoxicity, in the absence of infectious agents or neoplastic process, suggests an immune-mediated process, and ciclosporin A, a calcineurin inhibitor, would be the drug of choice. This is the first report showing resolution of both the clinical and histological signs of non-thymoma-associated exfoliative dermatitis.
一只6岁已绝育的雌性欧洲短毛猫因慢性、中度瘙痒性、脱毛性和剥脱性皮炎被转诊，该皮炎对抗寄生虫药、抗生素或甾体类抗炎药均无反应。这只猫出现躯干脱毛，全身有许多白色黏附性鳞屑。鉴别诊断包括皮脂腺炎、皮肤癣菌病、蠕形螨病、与胸腺瘤相关或不相关的剥脱性皮炎、药物反应、猫免疫缺陷病毒或猫白血病病毒相关的皮肤病、亲表皮性T细胞淋巴瘤，以及酵母和/或细菌过度增殖。血液检查结果在正常范围内，逆转录病毒检测为阴性。皮肤刮片、真菌培养、毛发梳刷和皮肤细胞学检查均未发现寄生虫或微生物成分。X线片未显示胸腺肿块的迹象。皮肤活检的组织学检查显示明显的正角化过度、淋巴细胞（CD3）界面性皮炎和毛囊壁炎，皮脂腺缺失，不同表皮层偶尔可见凋亡细胞。临床和组织学检查结果与非胸腺瘤相关性剥脱性皮炎综合征一致。给予环孢素A（7mg/kg），每日一次。3周后观察到显著改善。随着临床症状减轻，环孢素A的给药间隔逐渐延长。皮肤活检显示角化过度消退，炎症浸润消失，皮脂腺恢复。
在没有感染因子或肿瘤性病变的情况下，出现具有表皮细胞毒性迹象的T细胞浸润提示免疫介导过程，而钙调神经磷酸酶抑制剂环孢素A将是首选药物。这是第一份显示非胸腺瘤相关性剥脱性皮炎的临床和组织学症状均得到缓解的报告。
