Two unusual cases of facial dermatitis in cats
Apr 01, 2006
After finishing my residency at the University of California-Davis in 1994, I decided to remain on as a clinical instructor for an additional two years prior to starting my dermatology career in private practice. I really didn't know what I was getting into.
The owners felt the lesions appeared first, and then the pruritus followed. There are no other pets in the household, and he does not go to a groomer or kennel.A steroid injection was administered, and the owner reported it was helpful (but did not eradicate the lesions), yet he continued to flare once the steroid injection wore off. Another veterinarian felt he had a viral dermatitis and started him on antibiotics and oral lysine without success. Finally, a third veterinarian performed skin biopsies that alluded to a "hypersensitivity reaction".
He was administered a steroid injection every two weeks for a total of three injections without a favorable response. A hypoallergenic diet was attempted for six weeks without success. He continued to worsen with more crusts forming on the face to the point where he was becoming anorexic. What further diagnostics would you perform?
These tests were all performed and returned as negative. The impression smear of the crust yielded degenerative neutrophils with occasional cocci bacteria and eosinophils. Blood work was normal except for a mild neutrophilia.
Treat to rule out ectoparasites, such as fleas, Cheyletiella, Notoedres? Rebiopsy? Submit the biopsy slide for a second opinion? Refer?
When your course of therapy according to your lab results is not resulting in improvement of the patient, you need to question the results. In this case, a second opinion was obtained by a second cutting of the biopsy tissue, and a different pathologist found Demodex cati mites. Casey then was treated with topical lime sulfur dip applied to the facial lesions every other day, and he continues to improve.