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Nonsteroidal Antiinflammatory Drug Toxicosis 695

• Be certain to notify the laboratory of suspected hyperadrenocorticism) and invasion of
organisms (adjustments to culture media neoplasms (mast cell tumor, histiocytic
VetBooks.ir ○ Bacterial culture and susceptibility testing: TREATMENT Diseases and Disorders
sarcoma) into abdominal organs.
selection and incubation times; precautions).
aerobic (Staphylococcus spp, Rhodococcus
equi, Nocardia) and anaerobic (Actinomyces)
○ Rapidly growing atypical mycobacterial Treatment Overview
culture Because the group of nodular skin disorders
○ Fungal culture for deep mycosis (many encompasses a wide variety of causes, treatment
are biohazards; never culture these in depends on identification of the specific cause.
house). Negative cultures support a
diagnosis of sterile nodular panniculitis, PROGNOSIS & OUTCOME
lupus profundus, sterile pyogranuloma/
granuloma syndrome, immune-mediated Varies: good to poor depending on the ability
conditions, or neoplasia. to identify and specifically treat the underlying
• For the detection of antibody deposition cause.
(lupus) and identification of infectious agents
that are sometimes difficult to culture or PEARLS & CONSIDERATIONS
typically found low in numbers (canine spo-
rotrichosis with direct immunofluorescence Comments
[DIF], leishmaniasis with polymerase chain A thorough and methodical diagnostic protocol
NODULAR SKIN DISORDERS Sterile nodular reaction [PCR]): DIF, fluorescent antibody is often necessary to confirm a specific cause.
lesion on nose of dog testing, immunoperoxidase staining, immu- Most common mistake is inadequate submission
nohistochemistry, immunostaining with of tissue. Take multiple deep wedge biopsy
• Surgical biopsies to obtain a sufficiently polyclonal bacillus Calmette-Guérin (BCG) specimens and/or use 8-mm skin biopsy punch.
deep sample to incorporate the panniculus. antibody (promising method), PCR
Optimal samples are obtained by deep wedge • Serologic testing Technician Tips
biopsy; otherwise, infectious agents may be ○ Coccidioides, Blastomyces, Cryptococcus, • Always wear gloves.
missed. If using a punch biopsy, be certain Histoplasma, Leishmania • Prepare for excisional biopsy or use 8-mm
to double punch to obtain the subcutaneous ○ Urine antigen test for Blastomyces skin biopsy punch.
fatty tissue. Use an 8-mm skin biopsy punch. • Additional laboratory tests • Make at least four extra unstained slides from
• Dermatohistopathologic evaluation required ○ Feline leukemia virus/feline immunode- fine-needle aspirates for special staining by
to ficiency virus (FeLV/FIV) referral laboratory.
○ Differentiate the cellular infiltrate ○ Antinuclear antibody (lupus profundus,
(neutrophils, histiocytes, plasma cells, SLE) testing Client Education
lymphocytes, eosinophils, multi-nucleated ○ CBC/serum biochemistry/urinalysis A thorough diagnostic evaluation is cost-
giant cells, neoplastic cells) ■ Rule out metabolic disturbances causing effective and allows targeted therapy. Many
○ Identify the presence of infectious immunosuppression. diseases presenting as nodules have a limited
organisms with the aid of special stains ■ Evidence of concurrent immune- window of treatment success before the disease
(Gomori-Grocott methenamine silver mediated process (e.g., autoimmune disseminates, making cure or durable remission
[GMS], periodic acid–Schiff [PAS], and hemolytic anemia) impossible.
Fite acid-fast stains) ■ Baseline before commencing any long-
○ Help direct advanced diagnostics term medications SUGGESTED READING
• Diagnostic imaging Miller WH Jr, et al: Muller & Kirk’s Small animal
Advanced or Confirmatory Testing ○ Radiographs: metastasis or infection dermatology, ed 7, St. Louis, 2013, Saunders.
• A biopsy specimen should be submitted dissemination
aseptically for tissue maceration and culture; ○ Abdominal ultrasound: clinicians should AUTHOR: Karen Moriello, DVM, DACVD
EDITOR: Manon Paradis, DMV, MVSc, DACVD
this often needs to be an explicit request to evaluate concurrent factors (pancreatitis,
the laboratory.

Nonsteroidal Antiinflammatory Drug Toxicosis Client Education
Sheet

BASIC INFORMATION (CNS), and hematologic effects are also • Elderly and very young animals are at higher
possible. risk.
Definition
The common toxicosis is due to acute over- Epidemiology GENETICS, BREED PREDISPOSITION
dose or chronic administration of a nonster- SPECIES, AGE, SEX Labrador retrievers are not considered at greater
oidal antiinflammatory drug (NSAID), most • Most cases are reported in dogs. risk for hepatopathies from carprofen, despite
commonly affecting the gastrointestinal • Cats are generally more sensitive than dogs the fact that one-third of the initially reported
(GI) tract or kidneys. Although uncom- because of a deficiency in enzymes that cases of hepatic syndrome were in Labradors
mon, hepatopathy, central nervous system metabolize these drugs. (likely reflecting popularity of the breed).

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