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Feline herpes virus-1 associated facial and perianal dermatitis in a cat
Abstract
We herein describe a feline case of facial dermatitis whose histopathological features resembled to those of FHV-associated ulcerative dermatitis. A 3-year-old, intact male domestic short-haired cat was presented with 2-years history of pruritic dermatitis that initially appeared on periocular area and extended toward the entire face. The cat had ocular discharge and conjunctivitis from 2-month of age. Clinically, skin lesions were characterized as erythema, erosions and ulcers covered with crusts on the facial and perianal area. Histopathologically, the facial lesion was characterized as interface dermatitis with hydropic degeneration at the basal layer, and single cell necrosis of keratinocytes. In addition, the epidermal and dermal necrosis infiltrated with eosinophils, and intranuclear inclusion bodies in keratinocytes were also recognized. Moreover, feline herpesvirus-1 gene was detected by a PCR analysis using a swab obtained from the crusted lesions. Based upon these findings, the present case was considered as having FHV-associated ulcerative dermatitis. Therapy including oral acyclovir and topical recombinant feline interferon omega resulted in marked improvement of the skin and mucosal lesions.
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Ulcerative dermatitis caused by feline herpes virus 1 (FHV-1) is an uncommon disease characterized by cutaneous ulcers secondary to epidermal, adnexal and dermal necrosis. Differential diagnoses for FHV-1 lesions include, but are not limited to, mosquito bite hypersensitivity and eosinophilic granuloma complex. Histopathological diagnosis of FHV-1 dermatitis is based on the detection of the intranuclear inclusion bodies. In cases where intranuclear inclusions are missing but clinical and histological findings are compatible with FHV-1 dermatitis, immunohistochemistry (IHC) and PCRs have been used. In this retrospective study, we evaluated the presence of FHV-1 by IHC and PCR in skin biopsies and compared the results of the two tests. Sixty-four skin biopsy specimens from cats with compatible lesions were reviewed and tested via PCR and IHC for evidence of FHV-1. Polymerase chain reaction was positive in 12 of 64 biopsies; PCR and IHC were positive only in two of 64 biopsies, and these cases were considered true positive cases. The higher number of PCR-positive cases was possibly attributed to amplification of viral DNA from a live attenuated vaccination, but a previous FHV-1 infection with subsequent amplification of latently inserted FHV-1 could not be excluded. If clinical signs and histopathology suggest FHV-1 infection in the absence of typical inclusion bodies, IHC is the preferred diagnostic test; PCR may be useful for initial screening, but due to false positives is not sufficient for a definitive diagnosis.
Ulcerative dermatitis of the nasal planum or haired skin of the face, associated with intranuclear inclusion bodies compatible with herpesvirus, was identified in nine cats. Clinically, lesions were ulcerative and crusted, and often persistent. A tenth cat had focal proliferative ulcerative stomatitis, also associated with intranuclear inclusion bodies. Microscopically, there was necrosis and ulceration associated with prominent eosinophilic inflammation. Intranuclear inclusion bodies were noted in all cases, within the surface or adnexal epithelium. Ultrastructural examination of skin from two cats revealed virions morphologically compatible with a herpesvirus. Polymerase chain reaction (PCR) specific for feline herpesvirus 1 on DNA extracted from fresh-frozen or formalin-fixed paraffin-embedded biopsy samples and/or consensus primer PCR with DNA sequencing performed on DNA extracted from formalin-fixed paraffin-embedded biopsy samples from seven cats revealed that the virus was indistinguishable from feline herpesvirus 1. PCR was negative in one of eight cats tested.
A review of case material from the Cornell University College of Veterinary Medicine from 1988 to 1996 identified 20 dogs and one cat with definitive or presumed erythema multiforme. An additional 24 dogs and five cats with definitive or presumed erythema multiforme were found in the veterinary literature. Erythema multiforme accounted for only 0.40% and 0.11%, respectively, of all the canine and feline dermatology cases examined over a 9-year period. German Shepherd dogs and Pembroke Welsh Corgis appeared predisposed. The condition was manifested as a vesiculobullous and/or ulcerative dermatosis in the majority of dogs and cats. In dogs, the most commonly affected body sites included the ventrum (especially axillae and groin), mucocutaneous junctions, oral cavity, pinnae, and footpads. Histopathological findings in cutaneous and mucocutaneous biopsy specimens were consistent with previously published criteria. In dogs, erythema multiforme occurred more frequently in patients receiving drug therapy. In cats, all cases of erythema multiforme were presumed to be drug related. Elimination of the associated trigger factor and supportive care usually resulted in resolution of the erythema multiforme within 1–2 weeks. Four dogs with severe idiopathic erythema multiforme were successfully managed with glucocorticoids or azathioprine.
A retrospective light-microscopic study was performed on 294 biopsy specimens of haired skin from cats with various feline inflammatory dermatoses and specimens from cats with normal skin. Conditions expected to frequently have apoptotic epidermal keratinocytes (AKs) (including erythema multiforme, systemic lupus erythematosus, thymoma-associated exfoliative dermatitis, solar dermatitis, and viral dermatopathies) were found to have significantly more AKs than other types of inflammatory dermatoses. Nevertheless, we found more than two AKs in many skin-biopsy specimens from inflammatory conditions not expected to have frequent AKs (especially those from ectoparasitic dermatoses). Only a single AK was found in 1/33 cats with normal skin.
Three cases of skin ulceration in cats are described. Herpesvirus was isolated from the ulcers. Treatment of one case with antibiotics and an antiviral agent was successful. The significance of the viral isolate is discussed.