Page 1111 - Problem-Based Feline Medicine

52 – THE CAT WITH NON-HEALING WOUNDS 1103

Treatment Cold agglutinin disease is a rare disease where cold-
reacting IgM erythrocyte antibodies cause autoaggluti-
Treatment involves surgical excision of the involved
nation in the cooler peripheral vasculature of the
fat pad.
extremities resulting in ischemic necrosis of the ear and
Glucocorticoids (prednisolone at anti-inflammatory tail tips and foot pads.
doses of 0.5–1 mg/kg q 24–48 h for 4–6 weeks) help
reduce inflammation. Clinical signs
Vitamin E 200 IU/cat/day may help reduce inflamma-
Typically there is cutaneous ulceration, which may be
tion.
crust-covered.
Lesions often involve the muco-cutaneous junctions,
Prognosis foot pads, nail–skin junction, oral cavity, inguinal
and axillary areas and extremities (ear and tail tips).
Traumatic panniculitis is often frustrating to treat if sur-
gical excision is not possible. Vasculitis may be associated with necrosis particularly
of pinnae, foot pads and tip of the tail.
Prevention Systemic signs such as fever and lethargy are not
uncommon.
Oxypentoxifylline (10 mg/kg q 12 h) and vitamin E
(200 IU/cat q 24 h) immediately following trauma may
help to improve tissue perfusion and stabilise cell mem- Diagnosis
branes.
Diagnosis is based on clinical signs and histological
Early debridement of necrotic fat following trauma is findings.
indicated to reduce inflammation.
Early and late lesions should be examined
histopathologically. For small ulcers, excise the entire
ulcer together with the marginal skin. For large ulcers,
VASCULITITIS AND MISCELLANEOUS an elliptical biopsy should be collected extending from
ULCERATIVE DERMATOSES grossly normal skin through the edge of the ulcer to the
ulcerated skin.
Classical signs
An accurate drug history is important.
● Ulcers and crusts (skin and/or
Diagnostic tests should be performed to rule-out con-
mucocutaneous junctions).
comitant neoplasia.

Differential diagnosis
Pathogenesis
Differential diagnoses which should be considered
Immune-mediated ulcerative dermatoses represent a
include bullous pemphigoid, systemic lupus erythe-
heterogeneous group of diseases in which the primary
matosus (SLE), discoid lupus erythematosus (DLE),
lesion is cutaneous ulceration.
vasculitis, cold agglutinin disease, erythema multi-
Vasculitis resulting in skin lesions is rare in cats. It may forme (EM), toxic epidermal necrolysis (TEN).
be associated with immune complexes secondary to
infectious or neoplastic disease, drugs and as part of Treatment
autoimmune syndromes, such as SLE or be idiopathic.
● Predisposed sites have minimal collateral circula- Treat the underlying disease if possible, and stop drug
tion such as the pinnae, paws and tail tip. treatment or change to a different class of drug if signs
● Ulceration and necrosis are typical. appeared during drug treatment.