泼尼松龙和霉酚酸酯治疗犬复发性小形多形红斑的疗效观察

Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, South Korea.

Top Companion Anim Med. 2023 Jan-Feb;52:100755. doi: 10.1016/j.tcam.2022.100755. Epub 2022 Dec 28.

A 3-year-old neutered male miniature poodle dog was referred with a 19-month history of unresolved dermatological signs despite long-term treatment. On physical examination, the dog had severe multifocal erythematous non-blanching patches and scales in the ventral trunk. Dermatological examination revealed Malassezia infection. Considering the history, clinical signs, and degree of infection, the possibility of a drug eruption appeared higher than that of Malassezia dermatitis. Therefore, bathing in lukewarm water was performed for 4 weeks without any other treatment, but there was no improvement. Subsequently, treatment for Malassezia dermatitis and differentiation from allergic dermatitis were performed, but there was still no improvement. A biopsy was performed, with the histopathology revealing lymphocytic interface dermatitis with keratinocyte apoptosis. Based on the histopathologic evaluation and clinical signs, the dog was diagnosed with erythema multiforme (EM) minor. Immunosuppressive therapy with prednisolone (1 mg/kg PO, twice daily) was initiated and had a good therapeutic effect. However, the lesion recurred after tapering the prednisolone dose (0.5 mg/kg PO, every other day). Therefore, steroid-sparing agents were added to the prednisolone regimen. Ciclosporin, azathioprine, and human intravenous immunoglobulin were administered in combination with prednisolone. Yet again, the lesion recurred when the dose of prednisolone was tapered to 0.5 mg/kg once daily. Mycophenolate mofetil (20 mg/kg PO, twice daily) was then added to the immunosuppressive regimen as a steroid-sparing agent, and complete remission was achieved and maintained even when the dose of prednisolone was tapered to 0.5 mg/kg every other day. This is the first reported case of recurrent EM successfully treated with a combination of prednisolone and mycophenolate mofetil, and this treatment option should be considered for recurrent EM.

一只 3 岁已去势的雄性迷你贵宾犬，在长期治疗后仍有 19 个月的未解决的皮肤迹象。临床检查，狗有严重的多灶性红斑性非压痕斑块和鳞屑在腹部。皮肤检查显示马拉色菌感染。考虑到病史、临床症状和感染程度，药物疹的可能性高于马拉色菌性皮炎。因此，进行了 4 周的温水浴，没有任何其他治疗，但没有改善。随后，进行了马拉色菌性皮炎的治疗，并与过敏性皮炎进行了区分，但仍无改善。进行了活检，组织病理学显示淋巴细胞界面性皮炎伴角质形成细胞凋亡。根据组织病理学评估和临床症状，该犬被诊断为多形红斑（EM）轻症。开始使用泼尼松龙（1mg/kg PO，每日两次）进行免疫抑制治疗，效果良好。然而，在减少泼尼松龙剂量（0.5mg/kg PO，隔日一次）后，病变复发。因此，在泼尼松龙方案中加入了类固醇节约剂。环孢素、硫唑嘌呤和人静脉免疫球蛋白与泼尼松龙联合使用。然而，当泼尼松龙剂量减少至 0.5mg/kg 时，每日一次，病变再次复发。然后，将霉酚酸酯（20mg/kg PO，每日两次）作为类固醇节约剂添加到免疫抑制方案中，即使将泼尼松龙剂量减少至 0.5mg/kg 隔日一次，也达到并维持完全缓解。这是首例成功用泼尼松龙和霉酚酸酯联合治疗复发性 EM 的病例，对于复发性 EM，应考虑这种治疗选择。