Canine neutrophile Dermatose (Sweet-like Syndrom): Eine Beschreibung von 3 Fällen

Zusammenfassung

Es wurden 3 Hunde mit plötzlich auftretenden erythematösen Hautveränderungen, Fieber und weiteren unterschiedlichen extrakutanen Symptomen vorgestellt, welche mittels klinischer, labordiagnostischer und histopathologischer Untersuchungen der caninen sterilen neutrophilen Dermatose zugeordnet werden konnten. Die Erkrankung ist sehr selten und mit dem Sweet-Syndrom (SS) des Menschen zu vergleichen. Entsprechend den 4 Formen des SS konnte in dieser Kasuistik der 1. und 3. Fall dem klassischen/idiopathischen SS zugeordnet werden, wobei die respiratorischen Symptome, als Prodromalstadium des SS, den Hautläsionen vorausgingen oder eine Infektion des Respirationstraktes als Trigger des SS anzusprechen ist. Der 2. Fall hingegen weist einen deutlichen und der 3. Fall einen möglichen Zusammenhang mit Pathergie als Folge einer vorausgegangen chirurgischen Versorgung (Fall 2 eine Tibia Plateau Leveling Osteotomy [TPLO] 20 Tage zuvor; Fall 3 eine Hemilaminektomie 90 Tage zuvor) auf, wodurch beide der 4. Form des SS zugeordnet werden können. Bei allen 3 Fällen ist eine adverse Arzneimittelreaktion als Trigger nicht sicher auszuschließen, da jeweils vor Diagnosestellung Medikamente eingesetzt wurden. Neben den häufigsten extrakutanen Symptomen wie Fieber und Neutrophilie, trat bei 2 der Patienten eine immunhämolytische Anämie auf. Als Therapieoptionen wird zusätzlich zu den etablierten immunsupprimierenden Medikamenten wie Prednisolon, Ciclosporin und Azathioprin auch Oclacitinib in das Behandlungsschema mit aufgenommen, ebenso wie ein Thrombozytenaggregationshemmer (Clopidogrel), welcher als Lehre aus dem 1. der vorliegenden Fälle zu deuten ist, der an einer pulmonalen Thromboembolie verstarb. Bei Fall 2 konnten alle Medikamente über 2,5 Jahre ausgeschlichen werden, seit 4 Jahren ist der Patient ohne Rezidiv. Fall 3 ist unter Therapie rezidivfrei.

Abstract

Three dogs were presented with a sudden onset of erythematous skin lesions, fever, and various extracutaneous signs, assigned to canine sterile neutrophilic dermatosis by clinical, laboratory, and histopathologic examination. This disease is very rare and comparable to Sweet syndrome in humans. According to the 4 forms of SS, the 1st and 3rd cases in this case report could be classified as classic/idiopathic SS. In this context, the respiratory signs may be a prodromal stage of SS preceding the skin lesions or possibly an infection of the respiratory tract was the trigger for SS. The 2nd case, on the other hand, shows a clear and the 3rd case a possible connection to pathergy as a consequence of a previous surgical treatment (case 2 a tibial plateau levelling osteotomy [TPLO] 20 days previously, case 3 a hemilaminectomy 90 days previously). This way, both may be assigned to the 4th form of SS. In all 3 cases, an adverse drug reaction as a trigger cannot be ruled out with certainty, as medication was used before the diagnosis was made in each case. Besides the most common extracutaneous signs such as fever and neutrophilia, immune-hemolytic anemia occurred in 2 of the patients. As therapeutic options, in addition to the established immunosuppressive drugs such as prednisolone, ciclosporin and azathioprine, oclacitinib is also included in the treatment regimen. In addition, administration of an antiplatelet agent (clopidogrel), which may be interpreted as a lesson learnt from the first of the presented cases, that died of pulmonary thromboembolism. In case 2, all drugs were tapered and eventually stopped over a period of 2.5 years and the patient has been without recurrence for 4 years. Case 3 is recurrence-free under therapy.

Schlüsselwörter

Sweet-Syndrom - Hund - Pathergie - Medikamentenreaktion - Immunhämolytische Anämie

Keywords

Sweet syndrome - dog - pathergy - drug reaction - immune hemolytic anemia

Publication History

Received: 03 November 2023

Accepted: 06 May 2024

Article published online:
24 October 2024

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