Pemphigus: Nasal Dermatitis Vulgaris

SHORT COMMUNICATIONS
A recent study has shown that plasma viral RNA concentrations are significantly higher in cats in the AIDS stage compared with cats in the asymptomatic or AIDS-related complex
stage (Goto and others 2000). Although plasma viral RNA levels were not assessed in the present study, clinical isolates of
FIV were made from each of the infected cats so that viruses
isolated from cats with different outcomes may be analysed
for features that may be related to their virulence in vivo. In
this way it is hoped that more will be learnt about the role of
viral factors in the pathogenesis of FIV infection.
ACKNOWLEDGEMENTS
The authors would like to thank the veterinary practices that
participated in this study and the staff of the Feline Virus
Unit. This study was funded by a vacation scholarship
awarded to M. H. L. by the Wellcome Trust. M. J. H. is supported by a Wellcome Trust Programme Grant.
I.................................I
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showing severe
depigmentation,
erosion and ulceration
of the nasal planum
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References
ADDIE, D. D., DENNIS, J. M., TOTH, S., CALLANAN, J. J., REID, S. & JARRETT, 0. (2000) Long-term impact on a closed household of pet cats of natural infection with feline coronavirus, feline leukaemia virus and feline
immunodeficiency virus. Veterinary Record 146,419-424
DIEHL, L. J., MATHIASON-DUBARD, C. K., O'NEIL, L. L., OBERT, L. &
HOOVER, E. A. (1995) Induction of accelerated feline immunodeficiency
virus disease by acute-phase virus passage. Journal ofVirology 69, 6149-6157
GOTO, Y., NISHIMURA, Y., MIZUNO, T., ENDO, Y., BABA, K., MOMOI, Y.,
WATARI, T., HASEGAWA, A. & TSUJIMOTO, H. (2000) Quantification of
viral ribonucleic acid in plasma of cats naturally infected with feline
immunodeficiency virus. American Journal of Veterinary Research 61, 16091613
HOSIE, M. J., ROBERTSON, C. & JARRETT, 0. (1989) Prevalence of feline
leukaemia virus and antibodies to feline immunodeficiency virus in cats in
the United Kingdom. Veterinary Record 125,293-297
KAHLER. S. C. (1996) FIV diagnosis not an imminent death sentence. journal
of theAmerican Veterinary Medical Association 209, 1832
MATSUMURA, S., ISHIDA, T., WASHIZU, T., TOMADA, I., NAGATA, S.,
CHIBA, J. & KURATA, T. (1993) Pathologic features of acquired immunodeficiency-like syndrome in cats experimentally infected with feline immunodeficiency virus. Journal of Veterinary Medical Science 55, 387-394
PEDERSEN, N. C., HO, E. W., BROWN, M. L. & YAMAMOTO, J. K. (1987)
Isolation of a T-lymphotropic virus from domestic cats with an immunodeficiency-like syndrome. Science 235, 790-793
Nasal dermatitis as a
manifestation of canine
pemphigus vulgaris
A. P. FOSTER, T. OLIVRY
PEMPHIGUS vulgaris is a rare autoimmune blistering skin
disease associated with the generation of autoantibodies that
target transmembrane desmosomal proteins in the epithelium. In human beings, early manifestations of pemphigus
vulgaris are characterised by a marked predilection of lesions
for mucous membranes and by circulating immunoglobin G
(IgG) autoantibodies binding to desmoglein-3 (Amagai and
others 1999). With disease progression, the distribution of
lesions shifts from mucosal to mucocutaneous, while autoantibodies recognise both desmoglein-3 and desmoglein-l
(Amagai and others 1999). The first cases of canine pemphigus vulgaris were reported by Hurvitz and Feldman (1975)
450
FIG 1: Nose of the

German shepherd dog
and Stannard and others (1975), and since then a small number of cases have been described. Whereas most dogs with
pemphigus vulgaris exhibit lesions at the mucosal and mucocutaneous junctions (Scott and others 1987, Carlotti and others 2000), rare dogs are affected with a variant of the disease
without oral or mucosal involvement (Scott and others 1982,
Olivry and others 1992).
This short communication describes two dogs affected
with a variant of pemphigus vulgaris characterised by severe
nasal planum erosions and ulcerations reminiscent of other
immune-mediated dermatoses, such as cutaneous lupus
erythematosus.
Case 1 was a five-year-old male neutered German shepherd dog that was presented with a history of nasal dermatitis suspected of being of immune-mediated origin. Previous
treatment with oral and injectable corticosteroids resulted in
the partial remission of skin lesions but considerable weight
loss. At the time of referral to the dermatologist, the skin
lesions included focal painful erosions, ulcerations, crusting,
and depigmentation of the nasal planum (Fig 1) and also of
the lips, hard palate, scrotum and feet. Samples for serum biochemistry, haematology and urinalysis were within normal
limits. Antinuclear autoantibody serology was unremarkable.
Upon diagnosis, initial therapy consisted of vitamin E (800
units, every 24 hours), niacinamide and tetracycline (Oxycare;
Animalcare) (10 mg/kg, every eight hours), and oral prednisolone (1.5 mg/kg, every 24 hours). This protocol led to a
marked decrease in the severity of skin lesions.
After three months, vitamin E, niacinamide and tetracycline were stopped without further deterioration of the clinical signs. The dog has been in partial remission for the past
two years with low-dose oral prednisolone (approximately 0-5
mg/kg, every 48 hours).
Case 2 was a one-and-a-half-year-old female spayed
Australian shepherd dog with a five-month history of depigmentation and peeling of the skin on the nasal planum. These
lesions had rapidly progressed to ulcerations of the nasal
planum and perinasal skin. There was depigmentation of the
palate. Systemic signs were not present. Haematology and
serum chemistry were unremarkable. Before the diagnosis was
made, the dog had received a combination of tetracycline and
niacinamide (the same dosage as for case 1), which had led to
a minimal decrease in the extent of nasal lesions over a period
of six weeks. Upon diagnosis of pemphigus vulgaris, the dog
was given oral prednisone (0.5 mg/kg, every 24 hours) and
doxycycline (Ronaxam; Merial) (10 mg/kg, every 24 hours).
This regimen led to complete resolution of the lesions within
three months. When the doxycycline was discontinued, nasal
7,2001
The VeterInary Record,
The
Veterinary Record, April 7,2001
April
Veterinary Record (2001)

148,450-451
A. P. Foster, BSc, BVSc,
PhD, MRCVS, DipACVD,
Department of Clinical
Veterinary Science,
Division of Companion
Animals, University
of Bristol, Langford,
Bristol BS40 5DU
T. Olivry, DrVet, PhD,
DipACVD, DipECVD,
Department of Clinical
Sciences, College of
Veterinary Medicine,
North Carolina State
University, Raleigh,
North Carolina, USA
SHORT COMMUNICATIONS
References
FIG 2: Nasal skin biopsy

specimen of the
Australian shepherd
dog. Acantholysis with
resulting cleft formation
can be seen above the
stratum basale of the
nasal epithelium
(arrowhead).
Lymphocytic and
plasmacytic
inflammation is seen in
the superficial dermis.
Haematoxylin and
eosin. Bar= 140 pm
(low magnification), or
90 pm (high
mawnification
lvwj
*88058 111mu%ol insetl
ulceration reoccurred. Complete remission was achieved again

with the original drug combination. The dog has been in remission for the past two years with doxycycline (same dosage) and
low-dose prednisone (0.25 mg/kg, every 48 hours).
In both dogs, histopathological examination of lesional skin
biopsy specimens revealed similar findings. Intraepidermal
cleavage resulting from suprabasal acantholysis could be
detected (Fig 2). A band-like inflammation composed of lymphocytes and plasma cells also was evident in the superficial
dermis. Variable pigmentary incontinence and melanophagia
were observed, and these lesions were deemed consistent with
the diagnosis of nasal-predominant pemphigus vulgaris.
Direct immunofluorescence (IF) was performed on paraffinembedded skin biopsy specimens of both dogs, and revealed
intercellular epidermal deposition of IgG. Keratinocytebound immunoglobulin A, immunoglobulin M and C3 were
not seen. Serum circulating anti-keratinocyte autoantibodies
were detected by indirect IF using normal canine lip as the
epithelial substrate. In both dogs, a low titre of IgG autoantibodies was detected (1:100 for case 1 and 1:50 for case 2). To
confirm the identity of targeted autoantigens, an ELISA using
the recombinant extracellular segments of human
desmoglein-3 and desmoglein-1 (Ishii and others 1997) was
adapted to the canine species by using anti-canine IgG secondary antibodies as described by Olivry and others (2000).
This method established that both dogs' serum contained
autoantibodies directed against desmoglein-3 in amounts
that exceeded that of a human pemphigus vulgaris serum
(1 14 per cent and 46 per cent of canine pemphigus vulgarispositive control, respectively, at 1:500 dilution). Conversely,
the two sera did not exhibit high immunoreactivity against
desmoglein- 1 (20 per cent and 5 per cent of canine pemphigus vulgaris control, respectively, at 1:1000 dilution). These
findings were considered diagnostic for canine mucosal-predominant pemphigus vulgaris.
In conclusion, both dogs exhibited severe ulceration of the
nasal planum, a manifestation that would be suggestive of
various skin diseases including several cutaneous manifestations of lupus erythematosus, erythema multiforme, mucous
membrane pemphigoid, the uveodermatological syndrome,
as well as nasal aspergillosis and epitheliotropic lymphosarcoma. However, histological and immunological investigations were diagnostic for canine pemphigus vulgaris in both
patients. This predominantly nasal variant of pemphigus
vulgaris, which affects the planum but not the dorsal muzzle, therefore, needs to be added to the spectrum of clinical
manifestations exhibited by this disease in the canine species.
ACKNOWLEDGEMENTS
The authors thank Mr S. N. Clayton and Dr Janet Raczkowski
for case referral, and Mr Stan Dunston for performing the
immunological investigations.
The Veterinary Record, April 7, 2001
AMAGAI, M., TSUNODA, K., ZILLIKENS, D., NAGAI, T. & NISHIKAWA, T.

(1999) The clinical phenotype of pemphigus is defined by the antidesmoglein autoantibody profile. Journal of the American Academy of
Dermatology 40, 167-170
CARLOTTI, D. N., TERRIER, S., BENSIGNOR, E., COLLINOT, C. & PIERRA,
C. (2000) Pemphigus vulgaris in the dog: a report of 8 cases. Pratique Medicale
et Chirurgicale de L'Animal de Compagnie 35,301-307
HURVITZ, A. I. & FELDMAN, E. (1975) A disease in dogs resembling human
pemphigus vulgaris: case reports. Journal of theAmerican Veterinary Medical
Association 166, 585-590
ISHII, K., AMAGAI, M., HALL, R. P., HASHIMOTO, T., TAKAYANAGI, A.,
GAMOU, S., SHIMIZU, N. & NISHIKAWA, T. (1997) Characterization of autoantibodies in pemphigus vulgaris using antigen-specific ELISAs with baculovirus
expressed recombinant desmogleins. Journal ofImmunology 159, 2010-2017
OLIVRY, T., ALHAIDARI, Z. & GHOHESTANI, R. F. (2000) Anti-plakin and
desmoglein autoantibodies in a dog with pemphigus vulgaris. Veterinary
Pathology 37, 496-499
OLIVRY, T., IHRKE, P. J. & ATLEE, B. A. (1992) Pemphigus vulgaris lacking
mucosal involvement in a German shepherd dog: possible response to
heparin therapy. Veterinary Dermatology 3, 79-84
SCOTT, D. W., MANNING, T. O., SMITH, C. A. & LEWIS, R. M. (1982)
Pemphigus vulgaris without mucosal or mucocutaneous involvement in two
dogs. Journal of the American Animal Hospital Association 18, 401-404
SCOTT, D. W., WALTON, D. K., SLATER, M. R., SMITH, C. A. & LEWIS, R. M.
(1987) Immune-mediated dermatoses in domestic animals: ten years after
- Part 1. Compendium on ContinuingEducation for the Practicing Veterinarian
9,424-435
STANNARD, A. A., GRIBBLE, D. H. & BAKER, B. B. (1975) A mucocutaneous
disease in the dog resembling pemphigus vulgaris in man. Journal of the
American Veterinary Medical Association 166, 575-582
_ ABSTRACTS
Laryngeal paralysis in four
German shepherd dogs
FOUR juvenile white-coated German shepherd dogs developed the typical clinical signs, including stridor, of laryngeal
paralysis. The paralysis was bilateral in three cases and unilateral in the other, and one of the dogs also had megaoesophagus. Surgical treatment was successful in three cases, but
one dog had to be euthanased because of intractable regurgitation and aspiration pneumonia. A possible association
between the disease and the dogs' white coats is discussed.
RIDYARD, A. E., CORCORAN, B. M., TASKER, S., WILLIS, R., WELSH, E. M.,
DEMETRIOU, J. L. & GRIFFITHS, L. G. (2000) Spontaneous laryngeal paralysis in four white-coated German shepherd dogs. Journal of Small Animal
Practice 41, 558-561
Adverse drug reactions

A REVIEW article on adverse drug reactions proposed a new
definition: 'an appreciably harmful or unpleasant reaction,
resulting from an intervention related to the use of a medicinal
product, which predicts hazard from future administration and

warrants prevention of specific treatment, or lateration of the
dosage regime, or withdrawal of the product' They are classified
into six types (with mnemonics): dose-related (augmented);
non-dose-related (bizarre); dose-related and time-related
(chronic); time-related (delayed); withdrawal (end of use); and
failure of therapy (failure). Though medical, many statements
in this review are equally relevant to the veterinary field.
EDWARDS, I. R. & ARONSON, J. K. (2000) Adverse drug reactions: definitions,
diagnosis and management. Lancet 356, 1255-1259
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SHORT COMMUNICATIONS

FIG 1: Nose of the

Veterinary Record (2001)

FIG 2: Nasal skin biopsy

ulceration reoccurred. Complete remission was achieved again

AMAGAI, M., TSUNODA, K., ZILLIKENS, D., NAGAI, T. & NISHIKAWA, T.

Adverse drug reactions

product, which predicts hazard from future administration and

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