Canine stomatitis: an unusual presentation

Canine stomatitis: an unusual presentation

Nov 01, 2009

Brett Beckman
Stomatitis generally is thought of as a feline disease. Although it is seen much more frequently in cats, dogs can present with stomatitis as well.

Primary generalized stomatitis (affecting buccal mucosa and many times tongue margins and palatal mucosa adjacent to teeth) where no specific cause is detected is likely associated with a profound host immune response to oral microbes associated with plaque. Generalized stomatitis can be secondary to a variety of other diseases.

Photo 1: Profound generalized oral mucosal stomatitis and mucopurulent oral discharge in a 5-year-old Maltese.
A thorough evaluation of the patient is indicated when stomatitis is present. The dental case this month had an unusual presentation that resulted in an unusual diagnosis.

Photo 2: A severely erythematous palatal mucosa is uncharacteristic of stomatitis in the dog. (Photos courtesy of Dr. Brett Beckman)
A 5-year-old Maltese presented with profound generalized oral mucosal ery-thema, stomatitis and mucopurulent oral and nasal discharge with severe halitosis (Photo 1). The entire palatal mucosa was equally affected (Photo 2), but the margins of the tongue were not. Dried crusts of mucous almost obliterated the nasal openings bilaterally. The nasal discharge occurred some weeks following the onset of the oral signs. A previous biopsy from the referring veterinarian revealed inflammation consistent with stomatitis.

Photo 3:The nasal mucosa displayed significant erythema and discharge.
This patient did not show any reluctance to oral manipulation, which was quite uncharacteristic for this kind of presentation. Most patients with this pathology are in pain, so sedation often is required for a complete evaluation. Palpation of the tissue did, however, repeatedly induce avoidance behavior consistent with oral pain. Upon removal of the dried mucous crusts surrounding the nasal openings, nasal mucosal hyperemia was excessive, approximating the scale of that found in the oral cavity (Photo 3). Based on the initial biopsy at the referring practice suggesting primary stomatitis, what do you tell the owners at this point?