Page 1336 - Problem-Based Feline Medicine

1328 PART 15 CAT WITH EYE PROBLEMS

Diagnosis reported higher incidence in Persian and Siamese
breeds. Immune-mediated disease of other tissues is
Diagnosis is made on identification of yeast organisms
usually present by definition in SLE, for example:
on cytological examination of a Diff-Quik-stained speci-
● Immune-mediated polyarthritis: painful arthritic
men obtained by adhesive tape or touching a cotton bud
joints, lameness.
or slide to the affected area.
● Glomerulo-nephritis: chronic progressive signs of
Because the organism is a normal commensal of the polydypsia/polyuria and azotemia.
skin, diagnosis is based on identifying the organism ● Cats usually have other systemic signs such as
associated with a typical skin lesion, and resolution of fever, lymphadenopathy.
the lesion in response to treatment.
Diagnosis
Treatment
A provisional diagnosis is made on the appearance and
Malasezzia is responsive to topical therapy such as location of the skin lesions.
creams or lotions containing imidazoles, but applica-
Definitive diagnosis is made on histopathology of skin
tion is difficult because of the location.
biopsies.
Systemic antifungal therapy using ketaconazole or
High ANA titers are usually seen in SLE.
other imidazole may be better tolerated.
Differential diagnosis
IMMUNE-MEDIATED BLEPHARITIS Similar eyelid lesions can be seen in allergic blephari-
(PEMPHIGUS FOLIACEOUS, PEMPHIGUS tis, and in both conditions other lesions may also be
ERYTHEMATOSUS, SYSTEMIC LUPUS seen on the face, but these cases can usually be differ-
ERYTHEMATOSUS) entiated from pemphigus and SLE on biopsy.

Dermatophyte infections can be identified by micro-
Classical signs
scopic examination of hair shafts and culture.
● Alopecia, erythema, scaling and crusting of
Squamous cell carcinoma in the pre-cancerous stage
eyelids.
(“solar dermatitis”) can look similar to immune-medi-
● Lesions on ears, muzzle, temporal skin and
ated skin disease, but can be ruled out by biopsy of
nose (pemphigus erythematosus), or
affected skin.
nailbeds, nipples and other mucocutaneous
junctions (pemphigus foliaceous).
● Other immune-mediated disease (e.g. Treatment
immune-mediated polyarthritis,
Immunosuppressive doses of corticosteroids, e.g. pred-
glomerulonephritis) in SLE.
nisolone up to 2.5 mg/kg PO q 12 h, reducing as signs of
● Uncommon.
disease abate.
In more aggressive immune-mediated skin disorders
Clinical signs such as pemphigus foliaceous, other immune-modula-
ting drugs may have to be used to achieve control, e.g.
Uncommon disease in cats.
chlorambucil 0.1 mg/kg q 24 h.
Alopecia, erythema, scaling and crusting of eyelids.
Blisters are rarely seen as these are usually transient.
ECTROPION
Additional areas affected are the nailbeds, nipples and
other mucocutaneous junctions (foliaceous) and ears, Classical signs
muzzle, temporal skin and nose (erythematosus).
● Eyelid rolled outwards, making bulbar
Systemic lupus erythematosus (SLE) is a very rare conjunctiva more visible.
disease. It is more commonly seen in young cats with a