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Esophageal Diverticulum 309.e3

dermal lymphohistiocytic cell infiltration, Dermatologic Examination EM Minor EM Major SJS OS TEN
and subepidermal vesicles; hair follicles may Flat or raised, focal or multifocal, target Yes Yes No No No
VetBooks.ir • Because the histopathologic findings of (concentric rings around a clear or crusty center) Diseases and Disorders
be similarly affected. Skin biopsies also help
by excluding other differential diagnoses.
or polycyclic lesions
EM and SJS/TEN might overlap, clinical
classification should be considered to dif- Number of mucosal surfaces involved None or 1 >1 >1 >1 >1
<50
>50
Erythematous or purpuric, macular or patchy
<50
>50
>50
ferentiate these conditions. eruption (% of body surface affected)
Epidermal detachment (vesicles, bullae, erosions, <10 <10 <10 10-30 >30
TREATMENT and ulcers) (% of body surface affected)
Treatment Overview EM, Erythema multiforme; OS, overlap syndrome; SJS, Stevens-Johnson syndrome; TEN, toxic epidermal necrolysis.
Goals are to stop the immunologic reactions Adapted from Hinn AC, et al: Erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis in the dog: clinical
causing the epidermal necrosis, prevent skin classification, drug exposure, and histopathologic correlations. J Vet Allergy Clin Immunol 6:13-20, 1998.
infection if the cutaneous barrier is disrupted,
and provide supportive care if the animal is
debilitated.
• Use of glucocorticoids is controversial. Technician Tips
Acute General Treatment • Cyclosporine 5-7 mg/kg PO q 24h may be • With severe EM or SJS/TEN, close monitor-
• Try to find and correct the underlying cause. beneficial in some cases. ing of vital parameters (temperature, heart
If any drug is being administered at the time • Pentoxifylline 10 mg/kg PO q 8h has been and respiratory rates, blood pressure) is
of initial presentation, the first rule is to useful in some cases. necessary to adjust supportive care.
discontinue its use. • Intravenous human immunoglobulin (Ig) • Increasing the room temperature might be
• Mild cases of EM may resolve spontaneously infusion may be beneficial (cost and avail- helpful in thermoregulation.
after drugs are discontinued. ability are concerns).
• Severe cases of EM and SJS/TEN need • Severe oral ulcerations may require oral rinses SUGGESTED READING
supportive care: with chlorhexidine 0.1%-0.2% solution or Miller WH Jr, et al: Muller & Kirk’s Small animal
○ Fluid therapy if fluid deficits/electrolyte gel or viscous lidocaine 2% application to dermatology, ed 7, St. Louis, 2013, Saunders, pp
imbalances/acid-base disturbances the oral ulcers for comfort (p. 1002). 472-479.
○ Nutritional support
○ Maintain thermoregulation PROGNOSIS & OUTCOME ADDITIONAL SUGGESTED
○ Wound care (gentle washes with saline or READINGS
chlorhexidine gluconate 0.05% solution, • The prognosis is usually good for EM unless Hinn AC, et al: Erythema multiforme, Stevens-
dermal protection to prevent infection or the lesions are severe and extensive, but Johnson syndrome, and toxic epidermal necrolysis
desiccation, and topical antibiotics) prognosis is poor for TEN. in the dog: clinical classification, drug exposure,
• Necrotic epidermis, rich in cytokines, can • If an underlying cause is identified and and histopathologic correlations. J Vet Allergy Clin
help re-epithelialization. Some authors do eliminated, the condition should improve Immunol 6:13-20, 1998.
not recommend debridement of the skin within 3 weeks. Yager JA: Erythema multiforme, Stevens-Johnson
lesions unless it is infected. syndrome and toxic epidermal necrolysis: a com-
• Systemic antibiotic therapy is warranted if PEARLS & CONSIDERATIONS parative review. Vet Dermatol 25:406-e64, 2014.
there is evidence of bacteremia or sepsis; AUTHOR: Frédéric Sauvé, DMV, MSc, DACVD
may be considered if cutaneous ulcerations Comments EDITOR: Manon Paradis, DMV, MVSc, DACVD
are present • Ocular involvement has been reported.
○ If antibiotics were a possible precipitating • Some cases have been related to diet, and
cause, a different class of antibiotic should animals diagnosed with idiopathic disease
be used. should receive a hypoallergenic diet.

Esophageal Diverticulum Client Education
Sheet

Clinical Presentation
BASIC INFORMATION • Perforation or rupture with secondary
DISEASE FORMS/SUBTYPES pyothorax can occur with any type of
Definition • Congenital versus acquired diverticulum and can therefore see systemic
A rare disorder characterized by a pouch-like • Pulsion (true diverticula) versus traction (false signs of inflammatory disease and/or dyspnea.
sacculation of the esophageal wall, resulting diverticula)
in an area in which food or other material PHYSICAL EXAM FINDINGS
can accumulate HISTORY, CHIEF COMPLAINT • Regurgitation may be noted in the exam
• Regurgitation may be seen, particularly with room.
Epidemiology large diverticula. • No other findings are considered specific.
SPECIES, AGE, SEX • Prior thoracic inflammatory disease may
Can be found in dogs and cats of any age be suggestive (opportunity for adhe- Etiology and Pathophysiology
or sex sion formation and therefore traction • Pulsion diverticula are caused by herniation of
diverticulum). the mucosa through the muscular wall of the

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