Page 2066 - Cote clinical veterinary advisor dogs and cats 4th

1032 Vasculopathy, Cutaneous

• Familial canine dermatomyositis: collie, the central aspect of the footpads (some of • Routine CBC, serum biochemical profile,
Shetland sheepdog, corgi, and Beauceron these cases could be a rare manifestation of • Skin scrapings for focal (not ulcerated)
urinalysis: results are typically normal.
VetBooks.ir • Proliferative arteritis of the nasal philtrum: • Urticarial vasculitis: generalized pruritus • Diascopy for hemorrhagic lesions (e.g.,
shepherd
rabies vaccine–induced generalized ischemic
lesions
dermatopathy)
Saint-Bernard, giant schnauzers
associated with papules, purpura, and wheals
RISK FACTORS • Familial canine dermatomyositis: erythema, vasculitis does not blanch when a glass slide
is pressed over the top, in contrast to vascular
• Drug therapy ulceration, and mild crusting in the young dilation/congestion)
• Malignancy dog. Affected areas include face, pinnae, • Skin biopsy for histopathologic exam: it
• Infection (viral, bacterial, fungal, rickettsial) pressure points, digits, and tail tip. is often wise to submit tissue samples for
• Immune-mediated diseases • Rabies vaccine–associated vasculitis fungal and bacterial culture at the same
• Insect bites time.
• Food allergy Etiology and Pathophysiology
• Vaccines • Type III hypersensitivity reaction is suspected Advanced or Confirmatory Testing
• Trauma, burns as the primary pathomechanism. Antigen- Selected according to signalment and clinical
antibody complexes become trapped along features of case:
ASSOCIATED DISORDERS the basement membrane of vessel walls • Bacterial serologic titers (dogs: Rickettsia
Systemic lupus erythematosus (SLE) and activate the complement cascade. Type rickettsii, Ehrlichia canis, Borrelia burgdorferi)
I and II hypersensitivity reactions may also • Viral serologic titers (cats: feline leukemia
Clinical Presentation be implicated. virus [FeLV], feline immunodeficiency virus
DISEASE FORMS/SUBTYPES • Other mechanisms include [FIV])
• The lesions can be localized, regional, or ○ Direct antibody binding to the vessel wall • Coagulation profile, Coombs’ test, anti-
multifocal to generalized. ○ Antineutrophil cytoplasmic antibodies nuclear antibody (ANA) test, and rheumatoid
• Vasculitis is categorized histologically as (ANCA) binding to neutrophil granules factor test may be indicated based on
neutrophilic (leukocytoclastic, nonleuko- and the subsequent release of toxic history, physical exam findings, and initial
cytoclastic), eosinophilic, lymphocytic, mediators, leading to a bystander reac- database supporting immune-mediated
granulomatous, or cell poor. tion (granulomatosis with polyangiitis disease.
[Wegener’s granulomatosis] in humans) • Blood culture if sepsis is suspected
HISTORY, CHIEF COMPLAINT • Tissue culture of nodular or granulomatous
Patients may present with crusted or ulcerative DIAGNOSIS lesions
lesions that may be a cause for self-trauma. • Hypoallergenic dietary trial (urticarial form
Patients with urticarial vasculitis may present Diagnostic Overview of food hypersensitivity)
with erythematous and often pruritic wheals. Cutaneous vasculopathy is first suspected based on
the clinical presentation. The definitive diagnosis TREATMENT
PHYSICAL EXAM FINDINGS is based on a detailed history and skin biopsy.
• Description of the lesions varies according Treatment Overview
to the disease. Fever, anorexia, and lethargy Differential Diagnosis The goal is to improve circulation to the
may be present. • Cold-agglutinin disease affected area, control self-trauma, and suppress
• Proliferative thrombovascular necrosis of the • Disseminated intravascular coagulation the immune reaction while determining the
pinnae: notching of pinnal margins at tip • Frostbite inciting cause.
and/or well-demarcated ulcers on the concave • Demodicosis (focal lesions)
aspect of the pinna • Dermatophytosis (focal lesions) Acute General Treatment
• Idiopathic vasculitis: well-demarcated • Discontinue current drug therapies.
necrosis and ulceration, particularly at the Initial Database • Bandage pressure points and keep wounds
extremities and pressure points; may include • Thorough history to assess risk of drug- clean.
edema, alopecia, or crateriform ulcers on induced vasculitis • Prevent self-trauma (Elizabethan collar).

VASCULOPATHY, CUTANEOUS Weimaraner after a vasculitis episode. The
VASCULOPATHY, CUTANEOUS Typical punched-out paw pad lesion (arrows). dog responded to therapy but was left with a typical pinnal deformity.

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