Panniculitis Case Studies

INTERNAL MEDICINE CASE STUDIES Panniculitis in a 3 year old neutered female Border Collie A 3 year old neutered female Border Collie was presented to R(D)SVS Internal Medicine Service with an intermittent history of lethargy, inappetance and pyrexia of several weeks duration. On clinical examination, the dog was quiet but well hydrated with pink mucous membranes, a capillary refill time of less than 2 seconds. The heart rate was 150 beats per minute with no arrhythmia or murmurs. There were two focal nodules on the left hemithorax over the 6th rib and over the 9th rib on the right hand side which both caused discomfort when palpated. The rectal temperature was 40.3°C. Routine haematology showed a mild neutrophilia (15.4x109/l, ref. range 3.6-12). Serum biochemistry was unremarkable. Urinalysis was unremarkable and urine culture was negative. A biopsy of the nodular masses was performed which revealed severe, chronic active panniculitis. No acid fast organisms were observed on ZN staining and culture of the biopsies was negative. Due to the concerns that the panniculitis may be associated with an underlying disease, a wide range of additional screening tests were performed, all of which were negative. These tests included blood cultures, cPLI, PCR for Ehrlichia, Borrelia and Bartonella and Toxoplasma and Neospora serology. Echocardiography, thoracic radiographs and abdominal ultrasonography were all generally unremarkable. The dog was treated with prednisolone, vitamin E, ranitidine and sucralfate. The dog’s demeanour improved and the pyrexia resolved within 24 hours of starting prednisolone and she was subsequently discharged the same day. Panniculitis is an inflammatory condition of the subcutaneous fat, characterised by deep, cutaneous nodules that often become cystic and ulcerated and develop draining tracts. Many factors have been implicated in the aetiology of panniculitis in the dog including bacterial and fungal infections, lupus erythematosus, drug eruptions, trauma and pancreatic neoplasia and pancreatitis1-3. In many cases the underlying cause of the panniculitis can not be identified. The initial treatment for dogs with multiple sterile panniculitis lesions usually involves systemic glucocorticoids and appropriate therapy for any underlying diseases. page 1 of 2